What is a hematoma?
A hematoma is a pocket of blood inside the body caused by bleeding (hemorrhage). It forms when a blood vessel is ruptured or leaks blood into the surrounding tissue or body cavity. A bruise is a confined, mild type of hematoma.
Hematomas can occur just under the skin (subcutaneous hematoma), within muscles (intramuscular hematoma) and other soft tissues, under fingernails (subungual), and within the ear (auricular hematoma) or nose (septal hematoma).
You can also have bleeding in or around internal organs, such as abdominal hematoma, or inside your skull, which, depending upon its precise location, may be referred to as:
- Epidural hematoma, between the dura mater—the outer layer of the membranes (meninges)—and skull
- Subdural hematoma, under the dura mater
- Subarachnoid hematoma, on the surface of the brain, under the arachnoid layer of the meninges
- Intracerebral, or intraparenchymal hematoma, a blood pocket in the brain tissue itself
Hematomas can be caused by a wide variety of conditions. Any physical harm to your body can easily cause bruises of varying size, and head trauma can cause a hematoma in the skull. Certain conditions, diseases or disorders can cause a hematoma to form after only minor harm. For example, clotting disorders, such as hemophilia or Von Willebrand’s disease (hereditary bleeding disorder), cause easy bleeding.
Aside from the blood loss, a hematoma can cause problems for neighboring or distant structures. An expanding hematoma within an enclosed structure, such as the skull or the pericardial covering of the heart, can act like a tourniquet and interrupt the blood flow in nearby arteries and veins. In similar fashion, adjoining organs can be displaced or jeopardized by the fluid pressure caused by a hematoma. In the pelvis and extremities, a hematoma often forms following a bone fracture and may allow a significant portion of the body’s blood to pool and drain the circulation without being detected.
Treatment of a hematoma depends on its size, severity and location. Small, mild hematomas may not need treatment, though ice, rest, compression and elevation may help reduce associated symptoms and speed recovery. Doctors treat larger hematomas, or hematomas in or around other organs, in a variety of ways. Skull hematomas may require removing a portion of the skull temporarily or drilling a hole into the skull to reduce pressure on the brain.
Seek immediate medical care (call 911) if you suspect a hematoma due to head injury, especially if you, or the person you are with, is vomiting or experiencing confusion or loss of consciousness for even a brief moment.
Seek prompt medical care for a hematoma that is rapidly expanding or if you have experienced significant trauma, have a known coagulation (clotting) disorder, or are on anticoagulation (anticlotting) medications.
What are the symptoms of a hematoma?
A hematoma may accompany other symptoms that vary depending on the underlying disease, disorder or condition, as well as the hematoma location. A hematoma near the skin, such as a hematoma on the leg, is visible as a reddish area that may bulge out like a lump, depending on the amount of blood that pools. However, hematomas are not visible by eye when they develop deeper under the skin or internally.
Common symptoms that may occur along with hematoma
A hematoma may accompany other symptoms including:
- Pain around the hematoma
- Skin discoloration, which may change from red to blue to green to yellow in the days after the hematoma forms (like how a regular bruise changes color)
- Redness, warmth or swelling around the hematoma
Hematoma symptoms that may occur along with a head injury
Hematoma may accompany symptoms related to a head injury including:
- Abrupt changes in personality, such as anger or irritability, without an apparent cause
- Bone fractures or deformity, especially of the skull or face
- Clear or blood-tinged fluid coming from the mouth, ears or nose
- Confusion; drowsiness; clumsiness; memory loss; lethargy; or trouble speaking, seeing or hearing
- Difficulty breathing or not breathing
- Loss of control over bodily functions
- Pupils that are different sizes, or pupils that do not change when exposed to light and dark
- Seizure or unexplained shaking or convulsions
- Severe headache
- Unconsciousness and coma
- Weakness (loss of strength) or paralysis
Serious symptoms that might indicate a life-threatening condition
In some cases, hematoma may be a symptom of a life-threatening condition that should be immediately evaluated in an emergency setting. Seek immediate medical care (call 911) if you, or someone you are with, have any of these life-threatening symptoms including:
- Abnormal pupil size or nonreactivity to light
- Multiple, unexplained episodes of vomiting after a head trauma
- Neck or back injury
- Rapidly expanding or progressing hematoma, especially if you have a known blood clotting (coagulation) disorder
- Rapidly expanding or progressing hematoma, especially if you take blood thinners (anticoagulant medications)
- Severe bleeding from the head or face, especially if the wound is deep
- Slowed or stopped breathing
- Unconsciousness (even if brief) after trauma
What causes a hematoma?
When a blood vessel ruptures or is injured, blood can leak into the surrounding tissue where it collects and forms a hematoma. The most common cause of a hematoma is trauma or injury. A minor injury that affects small blood vessels, like capillaries in the skin, can result in a bruise. Injury to larger vessels can cause much more bleeding (hemorrhage) and larger hematomas, and injuries to the head can cause a hematoma to form inside the skull, which can compress the brain.
Hematomas may also form if your blood cannot clot properly because of a coagulation disorder, anticoagulant medications, or chronic disease.
Common causes of hematoma
Hematoma may be caused by a variety of conditions including:
- Anticoagulation medications, such as warfarin (Coumadin) or heparin
- Blood draw procedure (venipuncture) or intravenous catheter insertion
- Chronic diseases
- Coagulation disorders, such as hemophilia or Von Willebrand’s disease (hereditary bleeding disorder)
- Platelet deficiency (platelets are part of the normal blood clotting process)
- Trauma or injury
Serious or life-threatening causes of hematoma
In some cases, hematoma may be a symptom of a serious or life-threatening condition that should be immediately evaluated in an emergency setting. These include head trauma resulting in a skull hematoma or a pelvic fracture wherein a large quantity of blood can quickly accumulate unnoticed.
Questions for diagnosing the cause of hematoma
To diagnose your condition, your doctor or licensed healthcare practitioner will ask you several questions related to your hematoma including:
- When did you first notice your hematoma?
- Where is your hematoma?
- Do you remember what caused your hematoma?
- Have you ever had a hematoma prior to this occurrence?
- Do you have a history of blood clotting problems?
- Do you have any other symptoms?
- Are you taking any medications?
What are the risk factors for a hematoma?
A number of factors increase the risk of developing a hematoma. Risk factors for hematoma include:
- Aneurysm, including intracranial and intracerebral (brain) aneurysms
- Anticoagulant, antiplatelet or aspirin therapy to reduce the risk of blood clots
- Bleeding disorders, such as hemophilia
- Blood vessel disorders or damage
- Heavy alcohol use
- Injury, by either direct force or explosion/blast
- Liver disease, which can increase the risk of bleeding
- Older age, as skin and blood vessels become more fragile with time
- Platelet deficiency
- Vitamin deficiency, such as vitamin K (vitamin K is necessary for blood clotting)
Reducing your risk of hematoma
You may be able to lower your risk of developing a hematoma by:
- Discussing with your doctor the benefits and risks of any anticoagulant medicine you take, and what extra precautions would help reduce your risk of a bleed
- Medical follow-up after injuries and surgery
- Protecting your head and other parts of your body when engaged in risky activities, such as skateboarding, sailing, skiing, cycling, construction, contact sports, and climbing, among many others
- Treating underlying bleeding conditions as directed by your doctor
- Wearing a seatbelt
When should you see a doctor for hematoma?
For most hematomas visible as a reddish area or lump under your skin or nail, special medical treatment is not necessary. Ice packs for the first day or two will help reduce swelling and pain, and mild compression with an elastic wrap or bandage will help limit swelling—and remind you to protect the area!
Keep in mind hematomas are like a bad, swollen bruise, and we all know how long it takes a bruise to go away. However, hematomas arise from larger blood vessels compared to bruises, which result from damage to small vessels and capillaries. Expect at least a month for full healing, as the hematoma changes from red to blue to green to yellowish brown to your normal skin color.
Contact your healthcare provider if:
- The hematoma increases in size or becomes more swollen or painful in the following days.
- You notice signs of infection, which include redness, warmth, swelling, increasing pain, and fever.
- Self-care treatment does not improve your hematoma.
- Your hematoma does not dissolve after a month.
Hematomas can form anywhere in the body as a result of injury, certain medical conditions, or certain medications, and they are not visible to the eye. A physical exam, neurological exam, and blood and imaging tests, as necessary, can help your doctor determine the seriousness and extent of the hematoma and recommend the appropriate treatment.
Always see a doctor or other medical professional for:
- Any type of head injury
- Easy bruising
- Easy bleeding, such as frequent nosebleeds, bleeding gums, unexplained pain, or minor cuts that bleed excessively.
- Unexplained pain
- Multiple or recurring hematomas
- Serious injury, including from a fall, motor vehicle collision, or injury resulting in a broken bone
What are treatments for a hematoma?
At-home care for most hematomas under the skin and within soft tissues like muscles includes:
- Acetaminophen for pain if necessary (aspirin and other nonsteroidal anti-inflammatories can increase bleeding, so use caution and contact your healthcare provider for guidance)
- Elastic wraps to limit swelling
- Elevating the area to reduce swelling
- Ice packs several times a day to reduce swelling and pain the first 24 to 48 hours
- Warm compresses after two days of ice to help dissolve the fluid into the body
Similar to most subcutaneous hematomas, some internal hematomas are harmless and will dissolve on their own. Your doctor will determine the necessary treatment after a full evaluation.
Medical treatment of larger hematomas varies depending on the location and cause. Hematomas between the skull and brain may require removing part of the skull or drilling a hole into the skull to reduce pressure on the brain.
Other hematoma treatments may include:
- Altering the dosage of anticoagulant to reduce bleeding and hematoma formation
- Lifestyle changes, such as limiting or stopping alcohol use
- Medications to treat an underlying cause, such as vitamin supplementation for deficiencies, blood transfusions for platelet deficiencies, and clotting factors for bleeding disorders
- Medications to treat complications of hematoma, such as anemia or infection
- Surgery, such as procedures to drain or remove the hematoma, repair an injury, or treat an aneurysm
What are the potential complications of hematoma?
Mild hematomas or bruises are generally free of complications in healthy individuals. Larger or severe hematomas can have more serious complications, including hypovolemic shock from internal blood loss
or infection. Hematomas inside the head can cause life-threatening complications.
Because hematomas can be due to serious diseases, failure to seek treatment can result in life-threatening complications and permanent damage. Your primary healthcare provider will likely order blood tests, internal imaging tests (MRI, ultrasound or CT scan) or may refer you to a hematologist, a doctor who specializes in blood and bleeding conditions.
Once the underlying cause is diagnosed, it is important for you to follow your treatment plan to reduce the risk of potential complications including:
- Permanent disability
- Respiratory arrest