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 seep out into surrounding tissues where it does not belong. Small hematomas may resolve on their own, while larger ones sometimes require surgical intervention for healing. Here is an overview of hematomas and when surgery may be recommended for treatment.
What is a hematoma?
A hematoma forms when a blood vessel wall is damaged, allowing blood to leak out. Blood vessels can be damaged in a few different ways:
- Trauma – This includes injuries from falls, sports, car accidents, surgery complications, or violence/abuse.
- Spontaneous rupture – Sometimes a weaker blood vessel can rupture spontaneously, especially if a person has a condition that affects blood vessels like hypertension or atherosclerosis.
- Aneurysm – An aneurysm is a weakened, bulging spot on a blood vessel that can rupture and bleed.
- Certain medications – Blood thinners and anticoagulants can lead to excessive bleeding and hematoma formation.
When a blood vessel wall breaks, blood leaks out into the surrounding tissues and begins to clot. The pooled blood congeals and compresses the tissues, leading to swelling and pain. This collection of clotted blood is called a hematoma.
Types of hematomas
Hematomas can occur anywhere in the body. Some of the most common locations include:
- Scalp hematoma – Also called a “goose egg,” these occur on the head as a result of injury and can be associated with concussion.
- Ear hematoma – Bleeding between the cartilage and skin of the outer ear, often caused by trauma.
- Subungual hematoma – Bleeding and clotting under a fingernail or toenail, usually due to trauma to the nailbed.
- Retroperitoneal hematoma – Bleeding into the retroperitoneal space in the abdomen, which can be caused by trauma, rupture of an aneurysm, surgery complications, or bleeding disorders.
- Intracranial hematoma – Bleeding between the skull and brain. The most dangerous type is an epidural hematoma, where arterial bleeding causes rapid accumulation of blood that presses on the brain.
- Hepatic hematoma – Bleeding into the liver, often after a liver injury.
- Splenic hematoma – Bleeding into the spleen following trauma to the abdomen.
- Rectus sheath hematoma – Bleeding into the rectus abdominis muscle in the abdomen, typically seen in patients taking anticoagulants.
Signs and symptoms
The symptoms of a hematoma depend on its location in the body. Common signs and symptoms can include:
- Swelling, fullness, or a lump under the skin
- Bruising as blood leaks into surrounding tissues and skin
- Pain or tenderness when pressure is applied
- Injury to the area prior to the swelling developing
- Decreased function of the affected limb or body part
- Dizziness, headache, nausea, or neurological deficits if the hematoma is pressing on the brain or nerves
When might a hematoma need surgery?
Many small hematomas can heal on their own as the body slowly reabsorbs the collected blood. However, some larger or more severe hematomas may require surgery for treatment. Situations where surgery may be recommended include:
- Compartment syndrome – The hematoma swells and presses on nerves and muscles within an enclosed space or compartment. This can cut off blood flow and cause tissue damage if not relieved surgically.
- Epidural hematoma – Bleeding between the skull and dura mater causes rapid accumulation of blood that presses on the brain. This is a medical emergency requiring urgent surgery to evacuate the hematoma and stop bleeding.
- Expanding hematoma – A hematoma that continues to expand in size despite applying pressure. May be a sign of severe internal bleeding requiring surgery.
- Infected hematoma – If the hematoma becomes infected, surgery may be required to drain the infected material and treat the infection.
- Persistent bleeding – If the bleeding vessel cannot be stopped with applied pressure, surgery is often needed to locate and tie off or cauterize the damaged vessel.
- Impaired function – A large hematoma applying pressure on vital structures like nerves, organs, muscles, or joints may require surgical drainage or decompression.
- Cosmetic concerns – Some people elect to have large or disfiguring hematomas surgically drained for cosmetic reasons.
When to seek emergency care
In some cases, a hematoma can cause life- or limb-threatening emergencies requiring urgent medical attention. Seek emergency care for:
- Sudden, severe headache or neurological symptoms like weakness on one side of the body (signs of a possible brain hematoma)
- Head trauma with change in consciousness, severe headache, vomiting, or strange behavior
- Signs of shock like excessive bleeding, low blood pressure, rapid heart rate, dizziness
- Increasing pain, numbness, coldness, or blue/pale color in an extremity (possible compartment syndrome)
- Bleeding that cannot be stopped with direct, firm pressure
- Large hematomas that continue to expand in size
- Crushing injuries to the torso, pelvis or limbs
How are hematomas treated?
Treatment for a hematoma depends on its severity and location. Options may include:
- Rest – Resting the affected limb or body part can help minimize further injury and bleeding.
- Ice – Applying ice can help reduce swelling and pain.
- Compression – Firm, direct pressure to the site helps stop bleeding and prevent enlargement of the hematoma.
- Immobilization – Splinting or casting an injured limb may be needed to limit movement and prevent re-bleeding.
- Medications – Non-steroidal anti-inflammatory drugs (NSAIDs) help reduce swelling and pain. Avoid blood thinners as they can increase bleeding.
- Elevation – Keeping the affected limb elevated above the level of the heart uses gravity to minimize swelling.
- Surgery – Procedures like hematoma drainage, decompressive craniectomy, or vascular repair may be required in severe cases.
Most smaller hematomas improve gradually over weeks as the body reabsorbs the clotted blood. Larger hematomas may require active drainage and monitoring. Physical therapy is often helpful after surgical treatment to help restore normal function.
Risk factors
Anything that increases bleeding risk or causes blood vessel injury can lead to hematoma formation. Risk factors include:
- Trauma or injury
- Falls in older adults
- Contact sports like football, boxing, hockey
- Head injury
- Recent surgery
- Inherited bleeding disorders like hemophilia
- Blood thinners like warfarin or heparin
- Antiplatelet medications like aspirin, clopidogrel, ticagrelor
- Liver disease
- Excessive alcohol use
- Coughing excessively
- Pregnancy and childbirth
- Strenuous exercise, especially weightlifting
- Uncontrolled high blood pressure
- Atherosclerosis
- Vascular malformations like arteriovenous malformations or aneurysms
Prevention
While some hematomas cannot be avoided, taking certain precautions can lower risk in some cases. Prevention tips include:
- Wear protective gear during contact sports – helmets, face masks, padded gloves, shin guards
- Use proper safety techniques when weight lifting – avoid the Valsalva maneuver, use a spotter, avoid excessive straining
- Manage chronic conditions like hypertension and atherosclerosis
- Be very cautious taking blood thinners if at higher bleeding risk
- Remove hazards and install safety devices to avoid falls, especially for older adults
- Drive safely and avoid distracted driving
- Seek prompt medical treatment after trauma to help control bleeding
Conclusion
Hematomas often resolve gradually on their own, but larger or more severe collections of blood may need surgical intervention for healing. Seek prompt medical attention for any hematoma associated with significant pain, swelling, bleeding, neurological deficits, or other concerning symptoms. Controlling bleeding disorders, avoiding trauma, and managing chronic diseases can help lower risk of problematic hematomas.