What is a hematoma? What is a bruise?
A hematoma may have no visible signs, but a bruise will appear as localized discoloration.
A hematoma is a localized collection of blood in the tissues of the body outside of the blood vessels.
Also called a contusion or “black and blue mark,” a bruise is a discoloration of the skin that is a result of leakage of blood from capillaries into the skin.
What are causes and risk factors for bruises and hematomas?
Bruises and hematomas most commonly result from injury to the tissues. The tissue injury may be mild or severe. Risk factors for developing bruises or hematomas include:
- Contact sports (including soccer, football, basketball, rugby, lacrosse, and others)
- Slipping, falling, and tripping
- Abnormal compression on the skin
- Hypodermic needle injections
- Blood drawing
- Cupping treatments
- Blood thinning medications (aspirin, warfarin/Coumadin)
- Conditions or diseases resulting in diminished ability to coagulate blood properly (thrombocytopenia, bone marrow diseases, Von Willebrand disease, and others)
The conditions that cause severe inability to coagulate blood properly (thrombocytopenia, bone marrow diseases, Von Willebrand disease, and others) can cause spontaneous bruising and hematomas without tissue injury from trauma.
Bruising occurs more commonly with aging, especially with a significant history of repeated sun damage to the skin.
What are signs and symptoms of a hematoma or a bruise?
Hematomas may or may not be associated with symptoms, such as localized pain and tenderness. Because a hematoma often does not directly involve the skin, it may not have any visible appearance, or it may be associated with a tender raised area under the skin. If the hematoma is in an internal organ, it will not be visible. If a hematoma is seriously affecting an organ, that organ may have impaired function. For example, a hematoma in the brain can cause paralysis; a hematoma in the kidney may cause decreased kidney function.
A bruise will always appear in the skin as a localized area of discoloration. Originally, a bruise may appear bluish, blackish blue, or purple. Eventually, its color usually evolves to brownish, then light green as it fades. A bruise may or may not be tender. A typical sign of a bruise in the skin is that it does not blanch when pressed. Sometimes bruises are associated with tears in the skin.
Symptom of Hematoma & Bruise
Symptoms of a hematoma depend on the location, and whether the size of the hematoma or the associated swelling and inflammation cause nearby structures to be affected.
Common symptoms of inflammation from hematoma include pain and tenderness. Other symptoms of inflammation from hematoma include:
Bruises can be associated with tenderness of the involved discolored area.
When to seek medical care for hematoma or bruise
Seek medical care for any hematoma or spontaneous bruising that occurs without any known cause, so a health care professional can determine whether you have a serious underlying medical condition.
Both minor hematomas and bruising are common results of activities from daily living and usually require no specific treatment, other than avoiding reinjury.
Have a health care professional evaluate hematomas or bruises that are causing persisting pain
or diminished function.
What specialists treat hematomas and bruises?
All general medicine and family medicine specialists treat hematomas and bruises. Other health care professionals who treat hematomas and bruises include:
- Urgent care specialists
- Emergency room doctors
- General surgeons
- Nurse practitioners and nurses
- Internal medicine specialists
The specialists who are involved with treating hematomas and bruising often depends on any associated symptoms and whether internal organs have injury.
How do doctors diagnose hematomas and bruises?
Doctors can often diagnose hematomas located in the tissues just beneath the skin in the office during the history and physical examination. Swelling or tenderness in a local area can indicate a hematoma. Hematomas deeper in the body and in organs, such as the brain or spleen, can require radiologic imaging tests to detect them. These tests include CT scans, MRI scans, and others.
Doctors diagnose bruises clinically during the history and physical examination based on the characteristic discolored, non-blanching appearance of the skin.
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What are the treatments for hematomas and bruises?
Hematomas may not require any specific treatment, and the body eventually will biologically resorb the collection of blood over time. Initial treatment of a superficial hematoma can include cold compression. Later treatment, after all bleeding (hemorrhaging) has stopped, may include warm compresses to help reabsorbing the blood in the tissues. Serious hematomas, especially those affecting organs, can require surgical drainage to relieve pressure on the injured tissues. Occasionally, superficial hematomas under the skin can leave a fluid-filled sac, referred to as a seroma, after the body has biologically resorbed the blood. Seromas can also require a drainage procedure, either with a needle and syringe or via surgical operation.
Bruises only require avoiding reinjury and protection of involved skin. If there are associated skin tears, you can use topical antibiotics and a bandage.
What is the prognosis for hematoma and bruise?
The prognosis of hematomas and bruises is usually good. The prognosis can be serious if internal organs are injured or if the hematoma or bruising occurs spontaneously without injury, as this can represent a serious underlying medical condition.
How to prevent hematoma and bruise
To prevent hematoma and bruise, avoid physical trauma.
Medically Reviewed on 12/26/2019
Jameson, JL, et al. Harrison's Principles of Internal Medicine, Twentieth Edition (Vol.1 & Vol.2) 20th Edition. 2019.