A hematoma is a collection of blood outside of a blood vessel. It occurs because of an injury to the wall of a blood vessel, allowing blood to leak out into the surrounding tissues. Hematomas can occur anywhere in the body, but are most commonly seen under the skin.
What causes a hematoma?
There are several potential causes of a hematoma, including:
- Trauma – This is the most common cause. An impact or blow to an area can damage blood vessels and cause localized bleeding.
- Surgery – Surgical procedures that involve accessing blood vessels can potentially cause leakage and hematoma formation.
- Anticoagulants – Medications that thin the blood or affect clotting can increase bleeding risk and hematoma development.
- Blood disorders – Conditions like hemophilia impair clotting and make people prone to excessive bleeding and hematomas.
- Childbirth – Vaginal delivery can cause pelvic blood vessels to rupture, leading to vulvar/vaginal hematomas.
- Coughing/straining – Strenuous exertion can raise pressure and rupture vessels, like in a rectus sheath hematoma.
What are the types of hematomas?
Hematomas can be classified based on their location and severity:
- Cutaneous hematoma – Bleeding into the skin, causing visible bruising.
- Subcutaneous hematoma – Bleeding beneath the skin into the subcutaneous tissue.
- Intramuscular hematoma – Bleeding within a muscle, often seen in athletes.
- Retroperitoneal hematoma – Bleeding into the retroperitoneum behind the abdominal cavity.
- Subungual hematoma – Bleeding beneath a fingernail or toenail.
- Subdural/Extradural hematoma – Bleeding around the brain, between the dura mater and skull.
Hematomas can also be characterized by severity:
- Mild – A minor vessel leak causing minimal bruising.
- Moderate – More extensive bleeding and swelling.
- Severe – A major vessel rupture with large pooling of blood.
What are the symptoms of a severe hematoma?
The symptoms of a severe hematoma depend on the location but may include:
- Significant pain, swelling, and bruising at the site.
- Deformity, instability, and loss of function if it is within a muscle or joint.
- Dizziness, headache, nausea, neurological deficits with a subdural hematoma.
- Hypotension, weakness, low hematocrit with heavy internal bleeding.
How is a severe hematoma diagnosed?
Severe hematomas are diagnosed based on the history of injury and symptoms, along with some or all of these tests:
- Physical exam to assess pain, swelling, bruising, and function.
- Imaging tests like CT scan, MRI, or ultrasound to visualize bleeding.
- Testing for anemia and internal bleeding if severe.
- Assessing blood clotting function if bleeding is excessive.
What factors determine how long a hematoma will last?
The duration of a hematoma depends on several key factors:
- Cause – Traumatic hematomas may resolve faster than those from surgery or anticoagulants.
- Location – Superficial hematomas resolve quicker than deep ones.
- Extent of bleeding – Bigger hematomas with more blood leaked take longer to be reabsorbed.
- Treatment – Interventions like draining speed up resolution.
- Health condition – Hematoma duration is prolonged in bleeding disorders or on anticoagulants.
How long do severe hematomas usually last?
On average, the duration of severe hematomas is:
| Type of Hematoma | Usual Duration |
|---|---|
| Cutaneous (bruising) | 2-3 weeks |
| Intramuscular | 3-6 weeks |
| Subdural (head) | 4-6 weeks |
| Retroperitoneal (abdominal) | 4-8 weeks |
However, every case is unique. Some severe hematomas can last for several months if bleeding continues, is repeatedly aggravated, or fails to be absorbed normally.
What complications can a severe hematoma cause?
Complications of a severe hematoma include:
- Hypovolemic shock – Due to blood loss in major internal bleeding.
- Compartment syndrome – From pressure buildup within muscles.
- Infection – Of the hematoma blood collection itself.
- Loss of function – Impairment of nerves, muscles, organs compressed by the hematoma.
- Cosmetic defects – Large cutaneous hematomas may leave permanent skin changes.
How are severe hematomas treated?
Treatment options for severe hematomas include:
- Pain management – Rest, ice, compression, elevation, pain medications.
- Surgery to drain – Evacuating larger hematomas using incisions and drainage tubes.
- Tight pressure bandages – To limit bleeding and swelling.
- Blood transfusions – If severe blood loss caused by internal bleeding.
- Medications – Iron, blood thinners, antibiotics if needed.
- Physical therapy – To regain motion and strength once healed.
What is the prognosis and recovery time for a severe hematoma?
Recovery time for a severe hematoma depends on its location and extent. Some general timelines include:
- Cutaneous/subcutaneous – Often heal without issues within a few weeks.
- Intramuscular – May take over 6 weeks to fully recover strength and function.
- Subdural – Can take over 2 months to fully absorb, with risk of recurrent bleeding.
- Retroperitoneal – Requires prolonged monitoring for bleeding recurrence, infection.
Most hematomas will fully resolve without complications with proper treatment. However, some may leave behind fibrosis or calcification. Patient age, medications, and other medical conditions can also impact healing time.
When should a doctor be consulted about a hematoma?
It is important to see a doctor for:
- Rapidly expanding or worsening hematomas.
- Suspected deep muscle or internal organ hematomas.
- Head injuries with potential subdural/extradural bleeding.
- Excessive pain, swelling, functional impairment.
- Signs of hypovolemia like dizziness, palpitations, fainting.
- Fever or other signs of infection developing.
- Bleeding disorders or use of blood thinners.
- Cosmetic concerns about permanent skin dyspigmentation.
Minor cutaneous bruising may not require medical attention. But extensive, deep, or progressive bleeding warrants urgent evaluation to prevent serious complications.
Conclusion
The duration of a severe hematoma can vary substantially based on the location, degree of bleeding, and appropriate treatment. On average, recovery can take 2 weeks to 2 months depending on the type and location of hematoma. Prompt medical attention is crucial with major or progressive bleeding to prevent complications like hypovolemic shock, infection, or loss of function. While hematomas may take time to fully resolve, most people can recover well with proper care and follow-up.