Hematoma: Definition, Types, Causes, Symptoms, Diagnosis, Treatment, Prognosis and Complications

It is a pathological condition in which blood is collected outside the blood vessels.

Hematoma is usually caused due to injury or damage to the walls of a blood vessel that causes blood to leak out of the blood vessel into the surrounding tissues.

The hematoma can be caused due to any injury or damage to the blood vessel, be it an artery, vein, or even a tiny capillary.

Hematoma is a reasonably common condition, and everyone at some point in their lives suffers from this condition.

The bruise can most commonly be seen under the nails as a bluish discoloration when an injury to the finger, especially a crush injury.

Hematoma is a benign condition and usually resolves on its own over time as waste is removed and the body’s internal repair mechanism repairs the damaged blood vessel.

However, in some cases, especially when a bruise is developed in the brain or other sensitive areas of the body, such bruises must be removed surgically.


Different types of hematoma

A hematoma forms when a blood vessel ruptures or spills blood into the surrounding tissue or body cavity.

A hematoma ranges from a simple bruise (the “blue”) where the effusion of blood is more diffuse and superficial to internal and more extensive bruises.

Hematomas that occur on the skin’s surface are visible and disappear over time, but some bruises that form internally are not visible and may form a lump or clot.

These bruises are named based on their location. These types of bruises are:

Brain bruises

They are caused by bleeding inside the skull, which, depending on its precise location, can be called:

  • Subarachnoid hematoma: it develops within the brain tissue.
  • Subdural hematoma: is a type of hematoma that develops between brain tissue and the inner lining of the brain.
  • Epidural or intraparenchymal hematoma develops in the epidural space outside the dura.

Spinal Epidural Hematoma

This type of hematoma develops between the spinal vertebrae and the outer lining of the spinal cord.

Subcutaneous hematoma

This develops under the skin—the bruises, contusions, and subungual, aural hematomas of the scalp, among others.

Periosteal hematoma

It develops in the bone and is associated with fractures.

Intramuscular hematoma

It develops within the protruding part of the underlying muscle.

In this type of hematoma, the blood supply to the muscle is compromised, and structures such as nerves can be permanently damaged.

This occurs most frequently in the legs and forearm.

Intra-abdominal hematoma

The hematoma develops due to various injuries or diseases in the abdomen.

In organs such as the spleen (splenic hematoma), the liver (hepatic hematoma) as well as the kidneys, the walls of the small intestine (duodenum, jejunum, ileum), the large intestine (colon), the lining of the abdomen (peritoneum), in the retroperitoneal space.

Causes of hematoma

The hematoma is due to the rupture of larger blood vessels than in a superficial hematoma. Any physical damage to your body can cause bruises of varying sizes.

Injuries or trauma that cause damage to the blood vessels is the leading cause of the development of a Hematoma.

This damage or injury can disrupt the lining of the blood vessel wall.

Even minor damage to the blood vessel wall can cause blood to leak out of the blood vessel and cause a bruise.

Hematomas, which are localized blood collections, can be seen after any traumatic muscle injury.

Head trauma can cause a bruise to the skull.

Major bruising such as that of the brain or spinal cord is often caused by high-impact shocks that can cause severe internal bleeding that causes a bruise to form.

The most common cause of bruising is trauma that can occur as a result of:

  • From a brutal crash: balloon, fall of a heavy object, violent kicks or fists, etc.
  • The blows are repeated, especially in the practice of the sport (a toe that hits the shoe with each stride during a cross-country run).
  • From a traffic accident or a violent fall.

Hematoma is the most common early postoperative complication, occurring in approximately 5% of cosmetic surgery patients.

Fortunately, only 1% of bruises are considered significant or rapidly expanding bruises that require immediate surgical treatment.

Hematomas are most commonly the result of a trocar injury to the abdominal wall vessels in laparoscopic repair.

Hematoma can also be caused by surgery such as an incision and drainage, biopsies, or any surgical procedure.

This is because the procedure itself can damage the surrounding tissues and vessels, resulting in the formation of a hematoma.

Hematoma is the most common complication associated with venipuncture. Represents the extravasation of blood into interstitial spaces that surround a blood vessel.

The presence of blood in this space causes localized swelling and discoloration.

When venipuncture is successful, the needle itself acts as an obturator, sealing the hole in the vein wall during needle entry.

The hematoma forms without any known etiology or history of trauma in some cases.

People who take blood thinners are at increased risk of bruising.

This is because blood thinners impair the body’s ability to clot blood. Therefore, even if there is a mild injury to the blood vessel, it can be challenging to stop it, and repair of the ship becomes difficult.

However, it happens that the hematoma occurs even spontaneously. And it can be linked to:


You are taking specific treatments such as anticoagulants, especially vitamin K antagonists, such as Plavix, Persantine, coumadin, antiplatelet agents, especially aspirin, Vitamin E, anti-inflammatory or steroidal, garlic supplements.

Pathologies that lead to bleeding disorders

Certain medical conditions can cause bruising, such as infectious diseases, leukemia, and chronic liver dysfunction.

Certain conditions, diseases, or disorders can cause a bruise to form after minor damage.

For example, bleeding disorders, such as hemophilia, thrombocytopenia, or von Willebrand disease (inherited bleeding disorder), cause easy bleeding.

There are also certain conditions like alcoholism that can cause bruising.

In general, if bruising or bruising occurs spontaneously, it is essential to see a doctor quickly.

Risk factor’s

Certain factors can promote bruising or bruising, such as:

  • Age: blood vessels become more fragile and skin thinner in the elderly,
  • The female sex: women have thinner skin.

The symptoms

In some cases, even a large bruise may not produce any symptoms and may be an incidental finding in radiological studies performed for some other condition.

This is seen in cases of hematoma in the abdominal region where there is enough space for the hematoma to expand before any symptoms appear, while in subjects such as a subdural hematoma where there is much less space to expand the hematoma, there will be symptoms, experienced even if the size of the bruise is relatively tiny.

Some of the generalized symptoms of hematoma are pain, swelling, erythema, presence of a significant hematoma at the injury site. Still, usually, the signs of the hematoma depend on the location of the hematoma.

Thus, symptoms of brain bruising can include persistent headaches, confusion, altered mental status, trouble speaking, weakness on one side of the body, and in some cases, seizures.

When it comes to a spinal epidural hematoma, symptoms include persistent back pain, weakness, and bowel and bladder function loss.

Symptoms of subungual hematoma include discolored nails, nail paint, and nail loss.

Symptoms of a bruise within the abdominal area found within the spleen or liver include persistent and severe abdominal pain and flank pain.

Diagnosis of a bruise

If a patient is suspected of having a bruise, the treating physician will begin by taking a brief history of the patient, asking when symptoms started and if there is a history of injury or trauma to the area.

In the event of a suspected hematoma in the brain, the doctor will refer the patient to a neurologist or neurosurgeon who will examine the patient and order studies such as an MRI or CT scan of the head to determine the location hematoma and then formulate a plan. Treatment.

In cases where a bruise is suspected in the abdominal region, blood tests may be performed along with a chemistry panel and liver function tests to identify the cause of the bruise.

Then radiological studies with MRI and CT scans will be carried out to identify the exact location of the hematoma and then formulate a treatment plan more suitable for the patient.


Treatment of a bruise depends on its size, severity, and location. More extensive bruises or around other organs can be treated in several ways.

For minor bruises that do not cause any symptoms, no specific treatment is formulated, and the bruise is only monitored periodically by imaging studies to see if it increases in size or not.

Small and light bruises, although they may not need treatment.

Some actions help reduce associated symptoms and speed recovery:

  • Apply an ice pack for around fifteen minutes to the affected area and repeat the operation if necessary.
  • In combination with ice, applying a pressure dressing for less than ten minutes (or a cohesive band if the site involves a limb) can limit the extent of the hematoma.
  • It is possible to use a local preparation based on arnica.
  • Take a pain reliever: paracetamol or a non-steroidal anti-inflammatory drug (aspirin should be avoided) for minor pain.
  • In case of throbbing pain and bruising under the nail, the nail should be disinfected, and a nail puncture should be performed. The pin should be gently squeezed to evacuate the blood and relieve pressure. The nail is disinfected, and a bandage is applied.
  • In cases where an anticoagulant medication causes the bruise, consultation with the doctor to adjust the dose is sufficient to treat the bruise. Bruises that are suspected to be caused by some underlying medical conditions can be cured by treating the underlying cause.
  • For bruising to the brain, a surgical procedure will be recommended to drain the bruise as it enlarges. Hematoma in the brain can begin to compress other brain structures and pose quite severe problems for the patient.

Prognosis for hematoma

The overall hematoma prognosis is quite good as minor bruises resolve independently without any treatment in a few weeks to a month.

Sometimes it is replaced by fibrous tissue, which can interfere with the functioning of the organ, especially when it is a muscle.

Other complications of the hematoma are superinfection and compression of a nearby organ.

The doctor punctures the bruise to evacuate blood and relieve pain when necessary.

The prognosis for hematoma located in the brain is somewhat reserved since, during drainage of the hematoma, specific brain structures can be damaged and cause permanent or temporary disability for the individual.

Warning signs

Some situations should lead to an urgent consultation, such as:

  • Hematoma on the scalp, after a shock to the head, especially if the person has signs suggestive of head trauma: disorders of consciousness, tingling in the arms and legs, etc.
  • Hematoma after a direct and violent impact on the eye.
  • Hematoma is located at the level of the testicles.
  • A huge bruise at the level of the ear.
  • Hematoma is accompanied by an alteration of the general state: fever, severe fatigue, paleness.
  • Hematoma that becomes red, hot, and painful (a sign of infection).
  • Many bruises or ecchymoses occur spontaneously, with no apparent shock.


The severity of bruises varies widely, from a small-volume seroma to a significant, tense, expansive bleeding that threatens the viability of the skin flap.

In addition to blood loss, a hematoma can cause problems in neighboring or distant structures.

An expanding hematoma can act as a tourniquet and interrupt blood flow in nearby arteries and veins.

Similarly, adjoining organs can be displaced or compromised by fluid pressure caused by a hematoma.

A bruise often forms after a bone fracture in the pelvis and extremities and can cause much of the body’s blood to pool undetected.