Hematoma

A hematoma is a collection of blood, usually clotted, outside of the blood vessels, that occurs due to damage to the wall of a blood vessel – an artery, vein, or small capillary. It is generally caused by an injury, but can also result from surgical procedures or conditions that impair blood clotting. Hematomas can occur anywhere in the body, including the brain, and can range from minor to severe.

Upper Arm Bruise

Etiology

The term "hematoma" is derived from the Greek words "haima" (blood) and "toma" (mass or collection). It describes any localized collection of blood in tissues or a confined space, where it typically clots and can cause swelling and pain. Hematomas are a common occurrence and can range in severity from a minor bruise (also known as an ecchymosis) to a potentially life-threatening cranial hematoma.

Plateletpheresis hematoma 2016

Bruise Hematoma from abuse of spouse

Types of Hematoma

Hematomas are categorized based on their location. Some of the more common types include:

• Subdural hematoma: Occurring between the dura mater and the arachnoid membrane in the brain.
• Epidural hematoma: Occurring in the space between the dura mater and the skull.
• Subungual hematoma: Occurring under a fingernail or toenail.
• Intramuscular hematoma: Occurring within the muscle tissue.
• Subcutaneous hematoma: Occurring beneath the skin.

Causes

Hematomas are primarily caused by trauma or injury that leads to blood vessel damage. This could be from a minor injury, such as bumping into a table, or a major injury, such as a car accident. Certain medical and surgical procedures can also cause hematomas. Additionally, individuals with clotting disorders, or those taking anticoagulant or antiplatelet medications, may be more prone to developing hematomas.

Symptoms

The symptoms of a hematoma can vary based on its location, size, and the amount of inflammation it causes. Common symptoms include localized swelling, pain, tenderness, and discoloration of the skin (bruising). In severe cases, such as in brain hematomas, symptoms can include headaches, vomiting, dizziness, loss of consciousness, and neurological deficits.

Diagnosis

Hematomas are typically diagnosed through a combination of physical examination and medical imaging, such as ultrasound, CT scan, or MRI. The doctor will also consider the patient's medical history and the circumstances leading to the injury.

Treatment

Treatment of a hematoma depends on its size, location, and whether it's causing symptoms. Small hematomas often resolve on their own with rest, ice, compression, and elevation (RICE). Larger hematomas, or those causing symptoms, may require medical intervention, such as medication to manage pain, drainage of the hematoma, or surgery, especially in the case of brain hematomas.

Complications

While most hematomas are relatively harmless and resolve without treatment, they can occasionally lead to complications. These can include infection, nerve or tissue damage, and, in the case of cranial hematomas, increased intracranial pressure and brain damage.

See Also

• Bruise
• Subdural hematoma
• Epidural hematoma
• Hemorrhage
• Anticoagulant

References

• Servadei, F. (March 2010). "Clinical value of the Glasgow Coma Scale and the Full Outline of UnResponsiveness score in the evaluation of acute brain injury". Journal of Neurosurgery, 113(3), 729-730.
• Bullock, M.R., Chesnut, R., Ghajar, J., Gordon, D., Hartl, R., Newell, D.W., Servadei, F., Walters, B.C., & Wilberger, J.E. (2006). "Surgical Management of Acute Subdural Hematomas". Neurosurgery, 58(3), S2-16-S2-24.
• Nussbaum, E.S., Djalilian, H.R., Cho, K.H., & Hall, W.A. (March 1996). "Brain metastases. Histology, multiplicity, surgery, and survival". Cancer, 78(8), 1781-1788.
• Tollefson, M.K., & Leibovich, B.C. (2009). "Bladder injury during radical retropubic prostatectomy". The Canadian Journal of Urology, 16(6), 4940-4944.
• Wijdicks, E.F., & Kallmes, D.F. (April 2001). "Spontaneous lobar intracerebral hemorrhage: clinical and CT characteristics in 63 cases". American Journal of Neuroradiology, 22(4), 677-680.

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