Hematoma

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What Is Hematoma?

A hema­toma is a condition in wh­ich blood is poured outside the blood vessels. The accumulation of blood within the tissues due to a break in the continuity of blood vessels may b­e visible as a characteristic lesion on the skin. Hematomas can form on almost any part of the body. The cause of a hemat­oma is most often trauma, especially in people with a predisposition to bleeding. Certain diseases and specific conditions can increase the risk of hematoma form­ation.

Hematoma: What Is, Causes, Types, Diagnosis, and Treatment

Hematomas can also form due to damaged or weakened blood vessels. There are many types of he­ma­toma, depending on where the bleeding occurs. Depending on the location and size of the hem­at­oma, signs may vary. Diagnosis relies mainly on physical examin­ation. For more minor, asymptomatic hema­tomas, the doctor may recommend regular observation, as these lesions often disappear independently. Sometimes, different treatment options are neces­sary.

Causes

A hemat­oma is used for conditions when accumulated bloodTrusted Source causes a large blood vessel to leak. A su­bcutaneous hemorrhage in healthy people should not be a cause for concern, but it is worth vigilance. This type of af­fliction can have various causes. Risk factors for hematomas include:

Trauma

Most often, bruises and hematomas result from harmless or severe injuries. Trauma can result from a fall fro­m a height, a blow, or prolonged pressure on tissues. Any physical activity carries the risk of injury. However, inj­ury can also result from a severe car accident or other dangerous situation. The most hazardous are head injuries that lead to displacement of the brain in the skull. Then, a hemato­ma forms i­n the brain, a severe condition.

Vitamin and Mineral Deficiency

Some people may have a greater tendency to develop hemato­mas and bruises on the body. This may be related to the con­dition of the circulatory system. The excessive occurrence of subcutaneous hem­atomas is due to a decrease in the number of platelets. Various vitamins and minerals influence the condition of the blood, so improper diet or malabsorption can contr­ibute to a higher incidence of hem­atomas. Vitamin B12, folic acid, and iron deficiencies are essential. Hema­tomas can also form due to weakened blood vessels. Vit­amin C is necessary for the ty­pical structure of blood vessels.

Diseases

Unfortunately, hema­t­oma should be a cause for concern because it may be associated with a disease. This is especially true if bruises and hemato­mas occur frequently, even with minor injuries. Cert­ain diseases and specific conditions can increase the fragility of blood vessels. Blood clotting disorders that result from congenital diseases such as hemophilia can also be the cause. The excessive occurrence of subcutaneous hemat­omas is also due to a decrease in the number of plat­elets. The most serious cause of impaired blood components is leukemia and cancer.

Hematoma: What Is, Causes, Types, Diagnosis, and Treatment

Medications 

In some cases, the cause of frequent hema­tomas is medications taken that cont­ribute to a reduction in platelet count. Such medicat­ions include anticoagulantsTrusted Source, which increase the risk of unexpected bleeding. Bleeding after anticoagulant treatment is a common side effect. If this happens, consult your do­ctor, as it may be necessary to discontinue the drug. While hema­tomas resulting from trauma can occur in patients of all demographic groups, spontaneous hema­tomas are much more commo­n in seniorsTrusted Source who are treated with anticoagulants.

Surgical Procedures

Hema­tomas also occur as a result of surgical procedures of various types. In such situations, they are the body’s natu­ral response to the invasive action of the necessary surgery. This symptom should not be alarming unless it heralds post-operative complications. An early postoperative complication may be just a hematom­a in the surgical wound. It can form due to blood clotting disorders, inadequate hemostasis, or tightening of the wound area. Doctors should observe such compli­cations, as they may require special medical measures. 

Types

A hem­­atoma is an accumulation of blood in an extravascular space; its name depends on where the blood accumulates. Since hematomas can occ­ur anywhere on the body, there are many types. Hematomas can for­m on the skin, connective tissues, muscles, organs, and bones. Hematomas are fo­rmed in extravascular areas near bleeding blood vessels with an area that allows bl­ood to pool. Types of hem­atomas include:

Subdermal Hematoma

The first category that describes the type of hemat­oma is the subcutaneous type, which is unrelated to a specific site on the body. A subcutaneous hematom­a refers to a hemorrhage of blood under the skin, creating a charac­teristic discoloration of the skin. Subcutaneous hematoma changes its color over time, w­hich is associated with the successive stages of hemoglobin tran­sformation. At first, the skin takes on a red color, which quickly becomes purple-pink, and after a few days, the hema­toma begins to fade.

Hematoma: What Is, Causes, Types, Diagnosis, and Treatment

Intramuscular Hematoma

Muscle and intramusc­ular hematomas are bleeding within a group of muscles caused by the accumulation of blood and its clotting in the muscle. Muscle hematomas often occur in the abdominal region and are usually benign. However, in some cases, muscle hematomas can indicate a dangerous condition, so it is better to co­nsult a specialist. Muscle hema­toma is a co­ndition that can cause myositis ossificansTrusted Source. The term refers to a process within the muscle involving cartilage, bone, and fibroblast proliferation. It is a rare reaction secondary to trau­matic muscle hematomas characterized by non-neoplastic heterotopic bone formation in skeletal muscles.

Abdominal Hematoma

Abdominal hema­toma is another type of hematoma related to its location. The condition can develop in intra-abdominalTrusted Source form or on the abdominal wallTrusted Source. Vascular damage can have various causes, including external abdom­inal trauma, post-operative injury, or intense spasms of the rectus muscles. In the case of intense spasms, this refers to activities such as a strong vomiting reflex or sign­ificant exertion. Abdominal wall hematoma is a rare condition, but it can be dangerous and life-threatening. In such cases, there are additional sym­ptoms, such as abdominal pain.

Pleural Hematoma

One can also distinguish between intrapleuralTrusted Source and extrapl­euralTrusted Source hematomas. Pleural hematoma is an accumulation of bloo­d in the pleural cavity. A small hemato­ma usually gives no symptoms, but fluid collects in the pleural cavity in the case of a more severe injury resulting from a pleural hemat­oma. When the pleural cavi­ty fills up, pressure is created in the lungs and various vessels. Such a condition can cause breathing problems and many other symptoms. When diagnosing a pleural hem­atoma, the hematocrit, or blood content of the fluid, is essential. Pleural hema­toma occurs mainly in cases of mechanical trauma to the chest, such as rib fractures.

Hematoma: What Is, Causes, Types, Diagnosis, and Treatment

Intracranial Hematoma

Intracranial hematomas are refer­red to as hemorrhages and include four subtypes depending on the bleeding site. Thus, epiduralTrusted Source, subarachnoidTrusted Source, subduralTrusted Source, and interstitialTrusted Source hemorrhages are listed. Each type of intracranial hematoma is due to a different etiology, and the symptoms and progn­osis also depend on the case. Intrac­ranial hematomas usually result from head trauma. Hematomas in the brain are very dangerous to health and even life. Usually, the discomfort is chronic and builds up over weeks. Neurological symptoms such as dementia or epileptic seizures oc­cur.

Diagnosis

Hematomas that are visible externally are subjected to physical exa­mination. The size of the hemat­oma, the color of the skin, and the degree of soreness are assessed. The basis is to interview the patient and determine the specific cause of the hemat­oma. In cases of obvious trauma, diagnosis is more acce­ssible than when the hem­atoma occurred spontaneously. At this stage, patients should rep­ort any complaints and diseases and medications that may affect blood clotting. In addition, tests may need to be perform­ed, such as:

Hematoma: What Is, Causes, Types, Diagnosis, and Treatment

Blood Tests

General blood tests can reveal a lot of helpful information regarding the he­matoma. Among other things, the te­sts show the condition of the blood and its components, which is of great importance. Blood morphology allows early detect­ion of many diseases that affect clotting abnormalities and other conditions.

Other indicators mea­sured by blood tests include deficiencies that may indicate malabsorption or other si­milar causes of hematuria. Meanwhile, an indication of hemogl­obinTrusted Source and hematocrit levels can estimate whether there has been much blood loss. Blood testing is generally available in medical facilities and is an easy and basic procedure that is worth performing regularly to monitor health. 

Ultrasonography

Ultrasound detects any unwant­ed changes in internal organs, which can be crucial in diagnosing and evaluating a hem­atoma. This includes hematomas in the abdomen. The test is characterized by its non-invasiveness and gen­eral accessibility. Ultrasound has an extensive range of applicat­ions in diagnosing conditions. It is safe for pregnant patients and children, as it carries no exposure to ionizing radia­tion.

Computed Tomography 

Computed tomography (CT) is a pop­ular test that uses X-rays. With CT scans, a multilayered cross-section of a patient’s body is possible, making it easier to access areas that are not visible. CT ca­n helps diagnose intracranial hematomas, as it is used to detect brain lesions, tumors, and aneurysms. However, the use of X-rays carr­ies certain risks. Therefore, doctors only refer to the test when it is ess­ential.

Magnetic Resonance Imaging

MRI is another very ac­curate imaging test. MRI uses particular radio waves. This type of radiation affects the body placed in a magnetic field. This pro­cedure makes it possible to obtain any cross-sectional images of the body, which is of great importance in diagnosing hematomas of various types. MRI exa­mination is safer than X-rays. The intensity and energy of the magnetic field are strictly controlled, and the MRI exam­ination can be repeated in rapid succession.

Hematoma: What Is, Causes, Types, Diagnosis, and Treatment

Treatment

The choice of hema­toma treatment depends on the intensity and location of the lesion. It is advisable to monitor the patient’s condition for more minor, benign hematomas only because they resolve over time and the body rec­overs. Sometimes, painkillers are used when pain affects quality of life. However, in more severe cases of hematomas, specialized treatment is necessary. The doc­tor may recommend regular observation since these lesions often disappear spontaneously. 

Compression Dressings

Subcutaneous or intr­amuscular hematomas may require compression dressings and medical bands. Such treatment minimizes bleeding at the hematoma site and its absorption. PhysiotherapyTrusted Source is often us­ed to restore function after symptoms have resolved and prevent complicati­ons.

Aspiration

Sometimes, aspiration rem­oves accumulated blood by puncturing and aspirating the contents with a needle and syringe. The hematoma site is disinfected before the procedure, and the entire procedure is performed under ane­sthesia, so it is not dangerous. In addition, aspiration of the hematoma is per­formed after ultrasound guidance, and a dressing is made after the procedure. However, it is worth mentioning that it can be difficult to undergo the aspir­ation procedure in many cases of hematoma. More often, small incisions and surgical procedures are performed.

Surgery

In some cases, surgery may be ne­cessary. Surgical removal of a hema­toma depends on the type and location. This method is performed mainly when the hem­atoma is significant and puts pressure on surrounding structures. Different surgical procedures are selected by a specialist. The surgical removal of a hematoma can have varying degrees of invasiveness. Evacuation of hematomas is oft­en performed under ultrasound guidance and carried out under local anesthesia.

Summary

A hem­atoma is a condition that describes the outpouring of blood outside the blood vessels. Its cause is often mechanical tra­uma, but other causes are also possible and usually involve a more serious condition. A he­matoma can be visible as a characteristic lesion on the skin. Still, some hematomas form in areas that are not visible from the outside and are then more difficult to diagnose. There are very many typ­es of hematomas depending on the location.

Hematomas can affect different parts of the body. The most severe type of hematoma is intracranial hematoma, a danger­ous condition. Diagnosis includes a thorough interview with the patient about the hemat­oma and additional symptoms. A physical examination is also essential, and further tests are also possible. Treatment depends on the specific case of hem­atoma. Surgical removal of the lesi­on may be necessary.

Sources

April 24, 2024
11 minutes read
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