What is a hematoma?

A hematoma is not a bruise. Depending on the cause, it can take anywhere from 1 to 4 weeks for a hematoma to go away.
A hematoma is not a bruise. Depending on the cause, it can take anywhere from 1 to 4 weeks for a hematoma to go away.

A hematoma is not a bruise. It is a pooling of blood outside of the blood vessels deeper in the skin than a bruise occurs. Trauma is the most common cause of a hematoma. Depending on the cause, it can take anywhere from 1 to 4 weeks for a hematoma to go away.

Bruises and hematomas commonly get confused with each other. A bruise happens when capillaries get damaged due to trauma and the blood seeps into the top layer of your skin, causing discoloration. A hematoma happens when blood pools and clots underneath the skin and forms a swollen lump.

Many injuries can develop a hematoma and give the area a firm, lumpy appearance. If you have an injury, you might have more than a bruise. It’s important to see your doctor if your bruise swells or becomes a firm lump, because it might mean something more severe happened under the skin.

Main symptoms

The symptoms of an intracranial hematoma — one within the skull — can cause pressure on the brain over time and cause:

An intramuscular hematoma is one that occurs within the fascia — the tissue that holds muscles and organs in place. An intramuscular hematoma is one that forms inside the muscles. 

Some signs to watch for if you think you might have an inter or intramuscular hematoma are:

  • Swelling in the affected area
  • Pain in the injured area

Hematoma causes

A hematoma occurs when there are damaged blood vessels beneath the skin. The blood has nowhere to go, since there is no opening in the skin for it to flow out of, and it begins to build up in the area. This causes tissue swelling and leads to other severe issues if not treated quickly.

Hematomas can occur around the brain if the head receives a traumatic blow. Blood vessels in the brain can rupture from the impact and cause swelling that cannot be seen on the surface.

This type can occur in two places, subdural or epidural. An epidural hematoma happens when blood pools between the skull and the outer layer of the brain (the dura mater). If the blood is underneath the dura mater, it is referred to as a subdural hematoma.

Who can get it?

Hematomas can affect anyone who gets injured. Athletes can sustain muscle trauma, people over the age of 60 are more prone to muscle injuries, and anyone else can receive an injury to their head or body that can result in a hematoma.

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Diagnosis for hematoma

Your doctor will discuss the nature of any trauma or injuries with you if you can. They’ll want a complete medical history as well, because conditions like hemophilia could cause excessive bruising or blood pooling.

Depending on the type of injury and where it occurred, doctors decide which action to take. Doctors may take x-rays of the area to make sure there are no broken bones and use an ultrasound to measure any hematomas.

If you’ve had a head injury, the doctor will assess the symptoms you’re having and order a CT scan or an MRI to get a look inside. 

Treatments for hematoma

Medicines

There aren't generally any medications that you can use to treat hematomas unless your doctor decides you need something to help you deal with the pain. They might give you some pain medication, muscle relaxers, or acetaminophen to reduce the swelling. 

Home treatments

Sometimes, hematomas can go away on their own. If you have a muscular hematoma, doctors generally recommend the RICE method — rest, ice, compression, and elevation to reduce the swelling and give it time to heal. 

Surgery

Muscular hematomas rarely require surgery unless they come from another injury, such as a bone fracture.

Intracranial hematoma treatments are different. These types can also go away on their own. If your doctor decides to let yours heal, they will prescribe rest and periodic observation. However, if your hematoma is serious enough, they may need to drill small holes in your skull to drain the blood. This procedure is called a craniotomy. 

If you’ve developed blood clots in the blood vessels in your brain, doctors will want to perform surgery to get rid of them.


 

Possible complications and side effects

An intracranial hematoma can have severe complications if left untreated. At the same time, there can be complications from letting it heal by itself or performing surgery. There are always risks of infections, bleeding, or further damage to your brain if a doctor performs a surgery to remove blood clots or drain blood from the skull.

Epidural hematomas can have some complications if left untreated. These are:
  • Compression of the brain, if there’s a lot of bleeding
  • Herniation
  • Seizures

What is the difference between a contusion and a hematoma?

Our skin, muscles, and organs create an intertwined system that makes our body function. Blood flows to each of them, delivering the oxygen, nutrients, and chemicals they need.

If this system is damaged by an impact or force, the blood vessels in the area can rupture and bleed. If there is no exit for the blood, it can pool and turn into a contusion or hematoma.

It’s important to understand the difference between a contusion and a hematoma. On the surface, they might appear similar, but they are two very different conditions with different treatments.

More commonly referred to as a bruise, a contusion forms when tissue beneath the skin is damaged. The capillaries and blood vessels that carry blood to the tissue are damaged, filling the area with blood. The blood pools beneath the skin’s surface and causes discoloration.

The skin becomes darker, sometimes red or purple with a yellowish tint to the edges, and it is generally smaller than a hematoma. Contusions can occur anywhere there is soft tissue damage. They typically go away within a few days.

Hematomas are similar to bruises, except they are more severe. They are much larger and deeper than contusions and swell because of the fluid that builds up in the area. The skin is dark red, or black and blue, and is painful and tender.

Hematomas that happen in different parts of the body have varied symptoms and significance to your health. Abdominal hematomas pool blood within the abdominal wall or inside the abdomen and can cause blood to build up within your internal organs.

Intracranial hematomas occur due to head injury. They involve blood pooling either inside your brain (intracerebral hematoma) or between your skull and brain (epidural hematoma).

Subcutaneous hematomas occur beneath the skin when blood accumulates in fat rather than muscle following impact or injury.

Septal hematomas occur in the area behind the nose, called the septum.

Subungual hematomas are blood pools underneath your fingernails and toenails.

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Symptoms of a contusion vs. a hematoma

Contusion and mild hematoma symptoms are similar. A deeper hematoma or intracranial hematoma has much more severe symptoms.

Symptoms of a contusion

Contusions are usually small and red or purple. They might swell slightly, and the muscles around the area will be stiff and sore.

Symptoms of a hematoma

An intracranial hematoma is among the more severe blood pooling types because it causes pressure on your brain to build. You might experience headaches, vomiting, nausea, slurred speech, and confusion.

Abdominal hematomas might not initially present many symptoms. Over time, swelling and tenderness in the abdomen begin, followed by abdominal pain.

Septal hematomas make the nose and area under the eyes swell and turn red or black and blue. You might experience nose bleeds or some clear fluid draining from your nose.

Causes of a contusion vs. a hematoma

An impact on soft tissue causes both contusions and hematomas. The main difference is that the impact’s force determines whether you will bruise or get a hematoma.

Causes of a contusion

Contusions are caused by minor blows or impacts on your skin. The small blood vessels rupture and let small amounts of blood flow out, causing the discoloration.

Causes of a hematoma

Hematomas are caused by more significant impacts that damage blood vessel walls underneath the skin and the muscles or organs. The blood pools much more quickly than in a contusion and symptoms begin to develop rapidly.

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Diagnosis of a contusion vs. a hematoma

Contusions are more straightforward to diagnose than hematomas. You and your doctor can tell a bruise from the discoloration and appearance of the injury. Hematomas may require more than a physical examination.

Diagnosing a contusion

Doctors perform a physical examination of your bruise and ask about the circumstances that caused it. If you’re bruising a lot or the contusion is recurring, let your doctor know so that they can test to see if you’re anemic or have another condition.

They’ll ask about your medications and family history to see if any hereditary conditions might cause recurrent bruising. If they feel it is necessary, the doctor will order an ultrasound, magnetic resonance imaging (MRI) scan, or computerized tomography (CT) scan to see if there are any deeper injuries.

Diagnosing a hematoma

Subcutaneous hematomas may not require more than a physical examination from your doctor. However, if you’re experiencing symptoms of a deeper hematoma, or it showed up after a significant injury or trauma, the doctor will order an ultrasound, magnetic resonance imaging (MRI) scan, or computerized tomography (CT) scan. These tests allow your doctor to see where the blood is coming from and to find any other injuries.

Treatments of a contusion vs. a hematoma

Treating a hematoma can be different than a contusion based on the severity of the injury.

Treating a contusion

Most contusions heal on their own within a few days. If you have a painful contusion, you can use the rest, ice, compression, and elevation (RICE) method to reduce the swelling and inflammation. If you see your doctor, they might prescribe some nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, to reduce any inflammation.

Treating a hematoma

Less severe hematomas will eventually heal on their own and can be treated with the RICE method. Doctors might prescribe a regimen of pain medicine or recommend NSAIDs to treat any inflammation.

If you have an intracranial hematoma, the doctor uses a surgical drill to create holes in your skull to drain the pooled blood and relieve pressure on your brain. If the injury is severe enough, you might receive other surgeries and treatments to stop the bleeding and drain the blood.

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Medically Reviewed on 2/28/2022
References
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Cedars-Sinai: “Subdural Hematoma.”

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Johns Hopkins Medicine: “Craniotomy.”

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