Hematoma

What is a hematoma?

A hematoma is a closed wound where blood collects and fills a space inside your body because it can’t flow or drain out. And if blood fills a space, it can start pushing surrounding tissues outward. Minor hematomas are common, and you can have them almost anywhere in your body.

Hematomas are a concern when they’re larger, press on surrounding tissues or happen because of dangerous conditions. But smaller ones in noncritical places usually go away and aren’t a cause for worry.

Types of hematomas

There are several specific types of hematomas, mostly organized by where they happen. They include, but aren’t limited to, the following:

• Breast hematomas
• Cephalohematomas in newborns
• Hematomas inside your skull, like subdural hematomas and epidural hematomas
• Internal bleeding like hemoperitoneum
• Rectus sheath hematomas near your abdominal muscles or other muscle hematomas
• Subchorionic hematomas during pregnancy
• Subungual (under the nail) hematomas of your fingernails or toenails

What are the symptoms of hematoma?

The bigger a hematoma is, the more likely it is to cause symptoms. They’re also likely to cause symptoms when they fill small spaces or are next to critical tissues. Some common symptoms of a hematoma include:

• Pain. Hematomas usually happen with injuries, so pain is one of the key symptoms.
• Bruising. Shallower hematomas commonly cause visible color changes. They can be tiny (like petechiae), slightly larger (like purpura) or very large (like bruises).
• Swelling. Hematomas can cause swelling (edema) as the pooled blood pushes surrounding tissues like muscles or skin outward.
• Nerve symptoms. Hematomas can press on nerves, causing a pins-and-needles (paresthesia) feeling, as well as numbness or nerve pain.

Dangerous symptoms

Hematomas inside your head are dangerous because there’s limited space for blood to fill. Blood filling that space will start pressing on your brain, eventually damaging it.

Warning symptoms from hematomas in your head include:

• A sudden, severe headache
• Weakness or paralysis, especially on one side of your body or face
• Nausea and vomiting
• Trouble speaking (aphasia) or swallowing (dysphagia)
• Loss of balance or trouble coordinating muscle movements (ataxia)
• Seizures
• Losing consciousness and coma

Internal bleeding inside your chest or abdomen that causes a large hematoma can also cause warning symptoms. They include:

• Trouble breathing or breathing changes, like breathing fast (tachypnea) or slow (bradypnea)
• Chest or abdominal pain
• Your skin noticeably turning pale (pallor), cold or clammy
• Severe pain, especially when it happens for an unknown reason or it seems much worse than you’d expect from the likely cause

What causes hematomas?

Traumatic injuries are a key cause of hematomas. Blunt force trauma can easily cause them because bleeding inside your body doesn’t have anywhere to go.

But penetrating injuries can also cause hematomas. When you have some kind of penetrating injury, your body plugs the opening as soon as possible through a process called hemostasis. But if bleeding continues inside your body after the opening seals, hematomas can develop.

Some specific, injury-related conditions that can cause hematomas include:

• Bone fractures, especially complete ones (where the break goes all the way through the bone)
• Broken nose, facial fractures or cauliflower ear
• Head injuries and traumatic brain injuries, especially ones that cause intracranial bleeds
• Internal organ injuries, especially ones that involve significant bleeding
• Medical procedures that cause issues like a blown vein from an intravenous (IV) line or internal bleeding after surgery
• Muscle contusions
• Ruptures and tears of various tissues inside your body
• Strain-related injuries like sprained joints

You can also develop hematomas from internal bleeding with conditions that don’t involve an injury or external cause. Conditions that can do that include:

• Blood vessel tearing like aortic dissections
• Clotting disorders like hemophilia
• Blood cancers like leukemia or lymphoma
• Damage from internal growths like tumors (including benign and malignant growths)
• Hemorrhagic strokes
• Internal organ damage from conditions like kidney stones
• Conditions that can cause digestive tract ulcers
• Nontraumatic brain bleeds from conditions like high blood pressure (hypertension)
• Ruptured aneurysms
• Infectious diseases that can cause internal bleeding, like viral hemorrhagic fevers

Complications

Hematomas usually don’t cause complications unless they involve a lot of bleeding. Complications that they can cause include:

• Hypovolemic shock
• Ischemia from lack of blood when hematomas press on blood vessels, stopping blood from flowing through
• Nerve compression symptoms

Other complications may be possible, depending on your health history and other factors. Your healthcare provider is the best person to tell you more about your specific complication risks.

How is it diagnosed?

A healthcare provider can diagnose a hematoma using a physical exam and imaging tests. A physical exam is especially useful if there’s been an injury. During these exams, your provider will look for visible skin changes, listen with a stethoscope and feel (palpate) with their hands. Palpating is especially useful because hematomas feel different from normal, healthy tissues. Your provider may also ask questions about your symptoms, how and when they started, etc.

Imaging scans are helpful for finding hematomas because they let healthcare providers see inside your body. Magnetic resonance imaging (MRI) is the best at showing hematomas, especially deeper ones. But MRIs take a lot longer than other scans, so providers may use the following:

• Computed tomography (CT) scans. These can show if hematomas in your skull are pushing on your brain tissue.
• Angiography. This test can help find internal bleeding and related hematomas.
• Ultrasound. This test can help providers see hematomas that are shallower or in specific places, like around your uterus.

Depending on factors like your symptoms and health history, your provider may recommend other tests. They can tell you more about how these tests can help.

How are hematomas treated?

Smaller hematomas usually don’t need treatment or are treatable with simple home remedies. For simple surface bruising or a sprained or twisted joint, use the RICE method:

• Rest, so the injury can start healing.
• Ice, and be sure to wrap ice packs in towels so you don’t get frostbite.
• Compression, like wrapping the injured part with an elastic bandage.
• Elevate, so the affected part is higher than your heart.

When hematomas are more serious, treatment starts with managing dangerous effects or complications. Examples include transfusing blood to make up for severe blood loss, or doing CPR to keep blood circulating if your heart stops.

When you’re not in imminent danger, treatment focuses on addressing whatever caused the hematoma. Examples include:

• Surgery to repair damaged blood vessels and tissues
• Procedures to drain hematomas like centesis (using a needle to pull pooled blood out of your body)
• Setting and immobilizing broken bones
• Removing pooled blood so it doesn’t press on surrounding areas and it’s easier for your body to heal
• Medications to help with blood pressure, clotting issues and any other related concerns

Your provider may recommend other treatments, depending on the details of your situation. They can explain the various options in detail and tell you about any possible complications or side effects.

Are hematomas preventable?

Most hematomas aren’t preventable because they happen unpredictably. But there are a few things you can do to reduce the odds of having them.

• Prevent injuries or limit their severity. You can do this by using safety gear like helmets and protective padding and wearing your seat belt in moving vehicles.
• Manage chronic conditions. This may help you delay or even prevent dangerous conditions like strokes and brain bleeds. It can also help avoid hematomas from bleeding/clotting disorders.
• Train and exercise cautiously. You can get hematomas from muscle and soft tissue damage, so preventing that damage lowers your odds of developing hematomas.

Hematomas can also happen from other chronic conditions. Talk to your healthcare provider about ways to prevent hematomas if you have a chronic condition that might cause them.

What can I expect if I have a hematoma?

What you can expect from a hematoma can vary depending on several factors. Its size and cause, your health history and many other factors can affect what you experience. Your healthcare provider can tell you more about what you can and should expect for your specific case. They can also tell you about the outlook for your condition and what you can do to improve it.

How do I take care of myself if I have a hematoma?

Taking care not to aggravate or worsen an injury that caused a hematoma is a key part of taking care of yourself. If you give it time to heal, that’s usually all you’ll need. If you have questions or concerns about how to help a hematoma heal, you should talk to a healthcare provider. They can tailor the information they provide so it’s accurate and helpful for your situation.

When should I call or make an appointment with my healthcare provider?

You should talk to or see a healthcare provider about hematomas if you have:

• Bruising that doesn’t heal within two weeks
• Frequent or recurrent bruising that you can’t explain
• Bruising along with other symptoms that could indicate a deeper issue (examples include muscle weakness, tingling or numbness, or color changes from lack of blood circulation)

When should I go to the hospital or emergency room?

You should get emergency medical care if you have any symptoms of dangerous conditions that involve hematomas. These symptoms include, but aren’t limited to, the following:

• Trouble breathing
• Losing consciousness
• Chest pain
• A sudden, extremely painful headache
• One-sided weakness or paralysis
• Trouble keeping your balance
• Vision changes
• Trouble speaking clearly
• Unexplained nausea and vomiting

What questions should I ask my doctor?

Some questions you may want to ask your healthcare provider include:

• What caused my hematoma?
• How severe is it?
• Can I self-treat it or do anything to care for it?
• Does it need professional treatment, and what are my treatment options?
• How long will my hematoma take to heal?

How serious is a hematoma?

Hematomas can range from minor to serious. The main things that determine how serious a hematoma is include:

• What’s causing it
• How big it is
• Where it is
• If it could damage or is damaging something around it
• If something about your current or past health could influence it and make it more serious