Hematoma - Causes, Symptoms, Diagnosis & Treatment

Hematoma: Internal Bleeding

Authored by Dr.Mohan Rao on 22 May 2015 - 11:55


Hematoma is defined as the collection of blood outside a blood vessel, caused commonly due to an injury to the blood vessel's wall leading to the drainage of blood out of the vessel into the surrounding areas. Hematoma can be caused by injury to any type of vessel such as artery, vein or a capillary. Hematoma generally describes bleeding which may be more or less clotted, while ongoing bleeding is called hemorrhage.

Hematoma is a common problem experienced by most of the people at some point of time in their lives. They can be seen under the skin or nails like purple colored bruises. Bruises under skin are also called contusions. Hematomas can also be caused deep inside the body which is not visible. Sometimes formation of a mass or lump can occur from a hematoma which can be felt on touching.

Hematoma can be of different types such as:

  • Subdural hematoma: is the hematoma which occurs between the inside lining of the brain and the brain tissue.
  • Spinal epidural hematoma: is hematoma between the outside lining of the spinal cord and the spinal vertebrae.
  • Intracranial epidural hematoma: is hematoma between the outside lining of the brain and skull.
  • Intra-abdominal hematoma: is hematoma inside the abdominal cavity.
  • Subungual hematoma: is hematoma which occurs under the nail.
  • Aural or ear hematoma: is hematoma between the overlying skin and the ear cartilage.
  • Hepatic hematoma: is hematoma inside the liver.
  • Splenic hematoma: is hematoma inside the spleen.

Hematoma is most commonly caused due to injury or trauma to a blood vessel. It happens due to damage to the wall of the blood vessel. Hematoma can occur even if a small capillary is injured. For example, subungual hematoma which occurs under a nail can result from a minor trauma to the nail.

Severe traumas can lead to more severe hematomas, for example, an accident with a motor vehicle or falling from a height can cause heavy bleeding underneath the skin or even inside the body cavities such as abdomen or chest.

Other causes which can result in a hematoma due to surrounding tissue damage include:

  • Surgeries of any type, such as invasive medical including biopsies, incision, cardiac catheterization.
  • Dental procedures
  • Injection of medications such as blood thinners, insulin or vaccines.

The symptoms of hematoma depend on the location and size of the hematoma. The common symptoms for all types of hematoma include pain, redness, swelling and disfiguring bruises. Some location specific symptoms are:

  • Subdural hematoma symptoms: Confusion, seizures, headache, neurologic problems such as weakness on one side, falling, difficulty in speaking.
  • Epidural hematoma symptoms: Weakness, back pain, loss of bladder or bowel control.
  • Splenic, peritoneal or hepatic hematoma symptoms: Flank pain, abdominal pain.
  • Subungual hematoma symptoms: Nail loss, nail pain and weakness or disfiguring nail.

The diagnosis of a hematoma includes a physical examination and a comprehensive medical history. Generally there is no specific blood test for the diagnosis of hematoma, but depending on the situation, tests such as blood coagulation time test, complete blood count, metabolic and chemistry panel and liver tests may be done to evaluate the underlying causes of the hematoma.

Hematomas occurring inside the body require imaging tests such as:

  • Computerized tomography: CT scan of the head is done to diagnose subdural hematoma. Ct scan of the abdomen is useful for detecting hematomas inside the abdominal cavity such as hepatic, intra-abdominal, splenic or peritoneal hematoma.
  • Magnetic resonance imaging (MRI) test is useful in detecting epidural hematomas. It is more reliable than CT scan.

The treatment of hematoma depends on the symptoms, location and the clinical situation. Some hematomas may not require any treatment, while some may be a medical emergency.

Simple home therapies: can be useful for treating superficial hematomas such as hematomas occurring under the skin or nails. Most of these can be treated with icing, resting, compression and elevation of the area.

Medical treatment:

Medical treatment may be required only when the hematoma is large and with severe symptoms. There is no specific medication for the treatment of hematoma. It is managed by the treatment of related symptoms. For example, the pain resulting from a hematoma is treated with pain killers such as acetaminophen.

Surgical treatment:

The location and symptoms of the hematoma dictate the type of surgical procedure needed to treat the hematoma. For example, urgent drainage by a neurosurgeon may be required to treat subdural hematoma causing symptoms such as weakness, headache or confusion. However, if the subdural hematoma is symptom-free, it is left alone and just monitored occasionally using imaging tests such as CT scan and MRI.

*Disclaimer This is not medical advice. The content is for educational purposes only. Please contact your doctor for any health care issues.