Dr. Ben Wedro practices emergency medicine at Gundersen Clinic, a regional trauma center in La Crosse, Wisconsin. His background includes undergraduate and medical studies at the University of Alberta, a Family Practice internship at Queen's University in Kingston, Ontario and residency training in Emergency Medicine at the University of Oklahoma Health Sciences Center.
Mary D. Nettleman, MD, MS, MACP is the Chair of the Department of Medicine at Michigan State University. She is a graduate of Vanderbilt Medical School, and completed her residency in Internal Medicine and a fellowship in Infectious Diseases at Indiana University.
Trauma is the most common cause of a hematoma.
When people think of trauma, they generally think of car accidents, falls, head
injuries, broken bones, and gunshot wounds, etc.. Trauma to tissue may also
be caused by an aggressive sneeze or an
unexpected twist of a limb. When a blood
vessel is damaged blood leaks into the surrounding tissue; this blood tends
to coagulate or clot. The greater the amount of bleeding that occurs, the larger
the amount of clot formation.
Blood vessels that are fragile may contribute to
hematoma formation. For example, an aneurysm or weakening in a blood vessel wall may spontaneously leak.
There are many people who take blood thinners (anti-coagulation) medications. Examples include warfarin (Coumadin),
aspirin,
clopidogrel (Plavix) and
prasugrel (Effient). These medications increase the potential for spontaneous bleeding and
for hematomas to expand because the body cannot efficiently repair
blood vessels and blood continues to leak through the damaged areas.
Occasionally, diseases may occur that decrease the
number of platelets in the blood stream (thrombocytopenia) or their ability to function. The
platelets are the cells that help initiate
blood clot and fibrin formation.
All of the above situations may exist independently to cause a hematoma or they may
occur together.
What are the types of hematomas?
Hematomas are often described based upon their location.
The most dangerous hematomas are those that occur inside
the skull. Because the skull is an enclosed box, anything that takes up space
increases pressure within that box and potentially impairs the ability of the
brain to function.
Epidural hematomas occur because of trauma, often to the temple, where the
middle meningeal artery is located. Bleeding accumulates in the epidural space,
outside the 'dura' which is the lining of the brain. Because of the way the dura
is attached to the skull, small hematomas can cause significant pressure and
brain injury.
Subdural hematomas also occur because of trauma but the injury is usually to
the veins in the brain. This causes a slower leak of blood, which enters the 'subdural' space
below the dura. The space below the dura has much more room for blood to
accumulate before brain function suffers. As people age, they lose some
brain tissue and the subdural space is relatively larger. Bleeding into the
subdural space may be very slow, gradually stop, and not cause
acute symptoms. These
'chronic' subdural hematomas are often found incidentally on
computerized
tomography (CT) scans as part of a patient evaluation for
confusion or because another
traumatic incident occurred.
Intracerebral hematomas occur within the brain tissue itself.
Intracerebral (intra= within + cerebrum=brain) hematomas may be due to bleeding
from uncontrolled high blood pressure, an aneurysm leak or rupture, trauma, tumor or stroke.
Scalp hematomas occur on the outside of the skull and
often can be felt as a bump on the head. Because the injury is to the skin and
muscle layers outside of the skull, the hematoma itself cannot press on the
brain. However, a scalp hematoma signals that there has been a head injury and
it is important to assure that internal bleeding has not occurred within the skull. There are
a variety of guidelines available to the health care practitioner to assist in
accessing whether a patient will require further testing
to explore any bleeding in the brain.
Aural or ear hematomas may occur if an injury causes bleeding to the outside
helix or cartilage structure of the ear. Often called boxer's, wrestler's ear,
or cauliflower ear, blood gets trapped between the thin layer of skin and the cartilage itself.
Since the ear cartilage gets its blood supply directly from the overlying skin,
a hematoma can decrease blood flow causing parts of the cartilage to shrivel and
die. This scenario results in a bumpy, deformed outer ear.
Septal hematomas occur with nasal trauma. A septal
hematoma may form associated with a broken nose. If not recognized and treated, the cartilage can
break down and cause a perforation of the septum.
Orthopedic injuries are often associated with hematoma formation. Bones are
very vascular structures
since the marrow is where blood cells are made. Fractures are always
associated with hematomas at the fracture site. Fractures of long bones
such as the
thigh (femur) and upper arm (humerus) can be
associated with a significant amount of bleeding, sometimes up to one unit of
blood or 10% of the body's blood supply.
Pelvic bone fractures can also bleed significantly since
it takes a large amount of force to break these bones and it is very difficult
to compress the
area to decrease the amount of bleeding. Pelvic hematomas are hidden and the
amount of blood loss may be difficult to assess.
Intramuscular hematomas can be very painful due to the
amount of swelling and inflammation. Some muscles are surrounded by tough bands
of tissues. If enough bleeding occurs, the pressure within these compartments
can increase to the point that a 'compartment syndrome' can occur. In this
situation, the blood supply of the muscle is compromised and the muscle and
other structures such as nerves can be permanently damaged. This is most commonly
seen in the lower leg and forearm.
Subungual hematomas are the result of rush injuries to the fingers or toes.
Bleeding occurs under the fingernail or toenail and since it is
trapped, pressure builds causing pain. Trephination, or drilling a hole through
the nail
to remove the blood clot, relieves the pressure and resolves the injury. A new
nail grows over time.
Bruises and contusions of the skin (ecchymosis) are terms that
describe subcutaneous hematomas. These occur due to trauma or injuries to
the superficial blood vessels under the skin. Individuals who take
anti-coagulant medication are more prone to subcutaneous hematomas.
Intra-abdominal hematomas and hemorrhage may be due to a variety of
injuries or illnesses. Regardless of how the blood gets into the abdomen, the
clinical finding is peritonitis
(irritation of the lining of the abdomen).
Hematomas may occur in solid organs such as the liver, spleen, or kidney. They may
occur within the walls of the bowel, including the small intestine (duodenum,
jejunum, ileum) or the large intestine
(colon). Hematomas may also form within
the lining of the abdomen called the peritoneum or behind the peritoneum in the
retroperitoneal space (retro=behind).
Passing clots or hematomas is a common complaint when women
menstruate. Blood
can accumulate in the vagina as part of the
normal menses and instead of flowing out immediately, it may form small blood
clots. Passing blood clots after
delivering a baby is also relatively common.
However, vaginal bleeding and passing blood clots or hematomas while pregnant is not normal and should be a sign to seek medical attention.
Hematomas may occur anywhere in the body. Regardless of how a hematoma is
described or where it is located, it remains a collection of clotted blood
outside of a blood vessel.
High blood pressure, also known as hypertension, is a repeatedly
elevated blood pressure exceeding 140 over 90 mmHg -- a systolic pressure above
140 with a diastolic pressure above 90. There are two causes of high blood pressure, primary and secondary. Primary high blood pressure is much more common that secondary and its basic causes or underlying defects are not always known. It is known that a diet high in salt increases the risk for high blood pressure, as well as high cholesterol. Genetic factors are also a primary cause. Secondary high blood pressure is generally caused by another condition such as renal hypertension, tumors, and other conditions. Treatment for high blood pressure is generally lifestyle changes and if necessary, diet.
Blood clots can occur in the venous and arterial vascular system. Blood clots can form in the heart, legs, arteries, veins, bladder, urinary tract and uterus. Risk factors for blood clots include high blood pressure and cholesterol, diabetes, smoking, and family history. Symptoms of a blood clot depend on the location of the clot. Some blood clots are a medical emergency. Blood clots are treated depending upon the cause of the clot. Blood clots can be prevented by lowering the risk factors for developing blood clots.
A stroke results from impaired oxygen delivery to brain cells via the bloodstream. A stroke is also referred to as a CVA, or cerebrovascular incident. Symptoms of stroke include: sudden numbness or weakness of the face, arm or leg. Sudden confusion, trouble speaking or understanding. Sudden trouble seeing in one or both eyes, sudden trouble walking, dizziness, or loss of balance, and/or sudden severe headache with no known cause. A TIA, or transient ischemic attack is a short-lived temporary impairment of the brain caused by loss of blood supply. Stroke is a medical emergency.
Dementia is a significant loss of intellectual abilities such as memory capacity, severe enough to interfere with social or occupational functioning. There are different criteria classification schemes for dementias such as cortical, subcortical, progressive, primary, and secondary dementias. Other conditions and medication reactions can also cause dementia. Dementia is diagnosed based on a certain set of criteria. Treatment for dementia is generally focused on the symptoms of the disease.
Jaundice is a yellowish staining of the skin and whites of the eyes (sclerae) with bilirubin, the pigment found in bile. Jaundice can be an indicator of liver or gallbladder disease, or it may result from the rupture of red blood cells (hemolysis).
Internal bleeding occurs when an artery or vein is damaged and blood to escapes the circulatory system and collects inside the body. Internal bleeding can be caused by a variety of situations such as blunt trauma, deceleration trauma, medications, fractures, and spontaneous bleeding. Treatment of internal bleeding depends on the cause of the bleeding.
Brain aneurysm (cerebral aneurysm) is caused by microscopic damage to artery walls, infections of the artery walls, tumors, trauma, drug abuse. Symptoms include headache, numbness of the face, dilated pupils, changes in vision, the "worst headache of your life," or a painful stiff neck. Immediate treatment for a brain aneurysm is crucial for patient survival.
A broken toe is one of the most common fractures among individuals. There are many causes of a broken toe, whether it is the big toe, middle toes, or little toe (pinky). Common symptoms of a broken toe include pain, swelling, stiffness, and bruising. A broken toe can be treated with buddy taping the toe. There are instances where a physician should be consulted for a broken toe.
Thrombocytopenia refers to a decreased number of platelets in the blood. There are many causes of thrombocytopenia such as decreased platelet production (viral infections for example rubella, mumps, chickenpox, hepatitis C, and HIV); increased platelet destruction or consumption (for example sulfonamide antibiotics, heparin, blood transfusions, and lupus); or increased splenic sequestration (enlarged spleen due to conditions for example liver disease, blood cancers, and more). Treatment of thrombocytopenia depends on the cause.
Fractures occur when bone cannot withstand the outside forces applied to the bone. Fractures can be open or closed. Types of fractures include: greenstick, spiral, comminuted, transverse, compound, or vertebral compression. Common fractures include: stress fracture, compression fracture, rib fracture, and skull fracture. Treatment depends upon the type of fracture.
A bruise, or contusion, is caused when blood vessels are damaged or broken as the result of a blow to the skin. The raised area of a bump or bruise results from blood leaking from these injured blood vessels into the tissues as well as from the body's response to the injury. Treatments include applying an ice pack and pressure to the area by hand.
Hydrocephalus is an abnormal buildup of cerebrospinal fluid (CSF) in the ventricles of the brain. The fluid is often under increased pressure and can compress and damage the brain. Symptoms of hydrocephalus vary with age, progression of the disease, and individual tolerance to the condition. Hydrocephalus is most often treated by surgery in which a shunt system is inserted.
Breast lumps in women can have a variety of causes such as breast inflammation, infection, injuries, cancer, and non-cancerous growths. Breast lumps in women are diagnosed with physical exam, mammogram, ultrasound, MRI, and biopsy. Treatment of breast lumps in women depend on the cause.
When a portion of the brain loses blood supply, through a blood clot or embolus, a transient ischemic attack (TIA, mini-stroke) may occur. If the symptoms do not resolve, a stroke most likely has occurred. Symptoms of TIA include: confusion, weakness, lethargy, and loss of function to one side of the body. Risk factors for TIA include vascular disease, smoking, high blood pressure, high cholesterol, and diabetes. Treatment depends upon the severity of the TIA, and whether it resolves.
There are several bones in the foot, and these bones can be broken (fractured) in a variety of ways. Falling from heights, dropping heavy objects on the foot, or stress fractures from running or walking. Treatment of a broken foot depends on what bone in the foot is broken.
A brain hemorrhage is a type of stroke caused when an artery bursts in the brain, causing localized bleeding in the surrounding tissue. Causes of brain hemorrhage include aneurysm, liver disease, brain tumor, head trauma, high blood pressure, and blood vessel abnormalities. Symptoms include sudden severe headache, nausea, vomiting, loss of balance, tingling, numbness, vision changes, loss of consciousness, and loss of fine motor skills. Treatment depends upon the cause, location, and size of the brain hemorrhage.
In the United States, head injuries are one of the most common causes of death and disability. Head injuries due to bleeding are generally classified by the location of the blood within the scull, these include: epidural hematoma, subdural hematoma, subarachnoid bleed, intracranial bleed, sheer injury, edema, and skull fracture. Some common symptoms of a head injury include: vomiting, bleeding from the ear, speech difficulties, paralysis, difficulty swallowing, and body numbness. Treatment of a head injury depends on the type and severity of the injury.
Cauliflower ear, or "Boxer's Ear" is caused by an injury to the ear, usually by blunt trauma from sports such as boxing, wrestling, or martial arts. When hematomas form, infection, and ear drum injury may occur in addition to hearing loss if not treated. Treatment goals are to drain blood from hematomas, treat infection, and at times antibiotics to prevent further infection.
Cauda equina syndrome is a medical emergency condition that is caused by the uncommon compression of the nerves at the end of the spinal cord. Symptoms of cauda equina syndrome include lower back pain, tingling and/or numbness in the buttocks and lower extremities, bowel or bladder incontinence, and weakness in the legs. Causes of cauda equina syndrome include herniated discs, hematomas, or infection. Treatment is generally prompt surgery.
The hand has several bones to include the wrist, palm, and fingers. Fingers are the most commonly injured part of the hand. The most common causes of broken fingers are a traumatic injury to the finger or fingers such as playing sports, injury in the workplace, falls, and accidents. Treatment for a broken finger may be as simple as buddy taping the broken finger to the adjacent finger, or if the fracture is more serious, surgery.
Hemophilia is one of a group of inherited bleeding disorders. Hemophilia A and B are inherited in an X-linked recessive genetic pattern and is more common in males. Symptoms of hemophilia include bleeding into the joints, muscles, GI or urinary tract, or brain or skull. Treatments for hemophilia is generally replacement of blood clotting factors.
Idiopathic means that the cause of the condition isn't known. Thrombocytopenic means there's a lower than normal number of platelets in the blood. Purpura refers to purple bruises caused by bleeding under the skin. Idiopathic thrombocytopenic purpura (ITP) is a bleeding condition in which the blood doesn't clot as it should. This is due to a low number of blood cell fragments called platelets.
Skin RSS
Healthy Living Tips
This site complies with the