What is the difference between a contusion and a hematoma?

A hematoma is very similar to a bruise, but when the blood vessels break, the blood gets stuck and pools in one place. No single hematoma is guaranteed to be worse than a contusion.
A hematoma is very similar to a bruise, but when the blood vessels break, the blood gets stuck and pools in one place. No single hematoma is guaranteed to be worse than a contusion.

No single hematoma is guaranteed to be worse than a contusion. Both conditions can form when your blood vessels break, and both conditions can vary in severity depending on the amount of damage done and what body part was injured. 

The real difference between a contusion and a hematoma isn’t a question of which one is better or worse. When the injury is equally severe, contusions and hematomas have similar symptoms and treatments. What makes them different is the way that your blood spreads out after your vessels are damaged. 

A contusion is the medical term for a bruise. A bruise is a distinct skin discoloration that forms when a blow or hit to your body breaks small blood vessels. Blood leaks out from the vessels and spreads into the layers of your skin and the fatty tissues underneath. If you have a contusion, it means that your blood spread out in a reasonably uniform distribution — it doesn’t pool in one particular area.  

A hematoma is very similar to a bruise, but when the blood vessels break, the blood gets stuck and pools in one place. It collects until the area becomes swollen with blood. A bulge can form underneath your skin. 

There are different types of hematomas based on where they form in your body. Examples of hematomas include: 

  • Subdural — on your brain’s surface
  • Subungual — underneath the beds of your fingernails and toenails
  • Hepatic — in your liver
  • Spinal

What are common causes of contusions and hematomas?

Anything that damages your blood vessels can cause a contusion or a hematoma. 

Common causes for both include: 

Conditions that are more likely to create contusions include: 

  • Thin skin — a natural result of aging
  • Bleeding disorders
  • Microscopic tears to blood vessels near your skin — most common in athletes

Conditions that are more likely to lead to hematomas include: 

How are contusions and hematomas diagnosed? 

Most of the time you’ll be able to diagnose a mild contusion or hematoma without medical help. The symptoms are distinct and can be obvious.

Your doctor might order imaging of the area if your contusion or hematoma is severe — or you suspect that it’s part of a larger injury. Imaging tests include: 

  • X-rays —  used to help diagnose broken bones in the region
  • CT scans — used to check for additional damage when your head’s been injured
  • Ultrasounds — used when you’re pregnant to make sure your baby isn’t in danger

Your doctor could order additional tests to see if you have a bleeding disorder if you bruise easily and frequently.  

What are symptoms of contusions and hematomas?  

You might not notice a contusion or a hematoma immediately after an injury, but it may also take time to develop noticeable symptoms. In some cases, it can even be days after your injury that you first notice a problem.

Symptoms of both contusions and hematomas can include: 

  • Pain — ranging from mild to severe, potentially non-existent if it’s a small enough injury
  • Tenderness — particularly when you put pressure on the region
  • Swelling — this is particularly true of hematomas, but bruised areas can feel swollen too
  • Discoloration — most typically the classic black and blue coloration of a bruise, but other colors can appear as your body heals  

Hematomas in different areas of your body can have specific symptoms of their own. For example, pain in your abdomen could be caused by a hematoma on your liver or spleen. Seizures, headaches, and loss of bowel control can all be symptoms of hematomas in different regions of your brain.

Hematomas can also feel warm because of the pooled blood. 

What are treatments for contusions and hematomas?

You’ll get the best results if you treat them as soon as possible. When the injury is mild, a treatment plan abbreviated as RICE is the best solution. RICE stands for: 

  • Rest — Try to use the injured area as little as possible.
  • Ice — Apply ice or a cold compress to the area for at least 20 minutes or on and off for up to 2 days.
  • Compress — Firmly apply pressure to the area with something like a bandage wrap to cut down on swelling, particularly once you’ve resumed using the injured area.
  • Elevate — Try to keep injured limbs above your heart since elevation reduces pain and swelling.

If the area is painful, you can take over-the-counter medications like acetaminophen and ibuprofen. Don’t use aspirin because it can increase bleeding. 

Over time, your body will most often recycle the blood and your symptoms will go away. Internal hematomas — ones that involve organs like your liver — are an exception. These require specialized treatments that are unique to your situation. 

Your doctor will evaluate your injury and determine the best treatment plan based on what they find.     

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Special considerations for head injuries

Any head injury could result in contusions and hematomas forming within and around your brain. Still, keep in mind that just because you have a head injury doesn’t automatically mean that you have a brain injury. Your brain has ways of protecting itself even when your skull is injured. 

Of course, you still need to have severe blows to your head checked out by a medical expert — especially if you lost consciousness for any length of time. 

Your head is one of the most dangerous areas for contusions and hematomas to form — but it could take days for noticeable symptoms to appear after your injury. This means that it’s better to be safe than sorry — get to a doctor as soon as possible after hitting your head. 

Swelling could create pressure that — over time — leads to serious brain damage, or the hemorrhaging blood in your brain could create a blood clot. Both of these problems will require surgery to fix. A surgeon will perform a craniotomy to open part of your skull and deal with the damaged area.  

Additional reasons to talk to a doctor 

Get medical help as soon as possible if you suspect that a broken bone or other severe injury has caused your contusion or hematoma. 

You should also get help if the discolored or swollen region steadily gets bigger over time — it could mean that you’re still leaking fresh blood into the area. Just make sure that you’re not confusing this with the natural way that a bruise seems to expand a few days after you get it — when the original blood has been pulled down by gravity.  

Other causes for immediate concern include: 

  • Sudden large bursts of swelling during your recovery phase
  • Numbness in your arm or leg underneath the injured region
  • Paleness or a change in your skin's normal coloration further down your limb — like in your hand when it’s your shoulder that was injured 

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Medically Reviewed on 6/27/2022
References
SOURCES:

American Blood Clot Association: "Hematomas."

MercyHealth: "Bruise or Hematoma."

Nationwide Children's: "Contusions and Bruises."

UCLA Health: "Cerebral Contusion and Intracerebral Hematoma."

University of North Carolina Wilmington: "Instruction Sheet: Bruise/Hematoma."