What is the difference between a contusion and a hematoma?

A hematoma is like a bruise but more serious. A hematoma is worse than a bruise because it's usually a sign of an injury deeper in the skin.
A hematoma is like a bruise but more serious. A hematoma is worse than a bruise because it's usually a sign of an injury deeper in the skin.

No matter your age, it's common to get bruises on occasion. Some people can bruise more easily and may not even remember how they ended up with the bruise. These types of bruises are nothing to worry about and usually heal in about a week. 

A hematoma is like a bruise but more serious. The healing process can take anywhere from a few weeks to several months depending on the cause, type of hematoma, and the individual. A hematoma is worse than a bruise because it's usually a sign of an injury deeper in the skin.

Both hematomas and bruises are caused by damaged blood vessels. You can think of a hematoma as a more serious version of a bruise. It forms when blood collects under the skin’s surface and becomes trapped. This happens after a bad injury or repeat trauma to an area of the body. 

Unlike bruises, hematomas usually form a raised bump at the injury site. This is because the blood is clotting under your skin and causing it to swell. Hematomas are a purplish color rather than black and blue like bruises.

What are the signs and symptoms of a hematoma?

While hematomas are similar to bruises, there are some key differences. Hematomas can be superficial, meaning they’re easy to see on the skin, or deeper and more serious. The type of hematoma you have will depend on your injury. 

Some signs and symptoms to look out for if you have a superficial hematoma include:

  • Tiny red dots on the skin (called petechiae), which can form from broken blood vessels 
  • Warm skin around the injured area
  • Skin feels spongy, rubbery, or lumpy
  • Area is firm to the touch 
  • Inflammation, swelling, or raised skin
  • Intense pain or tenderness in the area
  • Discoloration or redness 

Some hematomas may show little to no signs at the injury site, but cause different symptoms like headaches or weakness. These types of hematomas include: 

Subdural hematoma

A subdural hematoma forms when blood builds up on the surface of the brain. Subdural hematomas can cause headaches and feelings of dizziness or confusion.

Epidural hematoma

An epidural hematoma occurs when blood forms in between the skull and the dura (the membrane that covers your brain). This type of hematoma can cause you to feel weak, drowsy, or confused.

Subungual hematoma

A subungual hematoma forms when blood gets trapped underneath your nail. You might have symptoms like throbbing pain or pressure under your nail. Your nail may also turn black and blue. 

Hepatic hematoma

A hepatic hematoma occurs in your liver. It can cause symptoms like pain in the abdomen, nausea, or a feeling of fullness after not eating much. This type of hematoma doesn't always display symptoms. You may need a CT scan or MRI to detect it. 

How do you treat a hematoma?

In most cases, hematomas heal on their own when the blood that clots is gradually absorbed back into your body. As the hematoma heals, you may notice it change in color, from purplish to blue, brown, then yellow until it finally heals. 

While the healing process can take anywhere from a few weeks to several months depending on the severity, there are some ways to treat a hematoma at home.

At-home treatments and medications 

Along with rest and protecting the injured area, here are some at-home remedies you can try:

  • Apply ice to the area using a plastic bag filled with ice or a bag of frozen vegetables wrapped in a towel (20 minutes on and 20 minutes off).
  • Apply heated compresses after the first 48 hours to help your body reabsorb the blood. You can do this 2 to 3 times per day using a warm washcloth.
  • If the hematoma is on your leg or arm, keep it elevated above the heart as much as possible.
  • Try to limit your activities, especially around the injured area, so that you don’t accidentally hit it and hurt it more.
  • You can take over-the-counter medications like acetaminophen to help lessen any pain you're having. Be sure to talk to your doctor first and only take up to 4,000 mg per day (two extra-strength capsules every six hours).
  • Once the clotting has stopped (usually after the first 24 hours), you can treat your pain with an anti-inflammatory like ibuprofen. These medications help with pain and are safe for people who don't have bleeding disorders. Make sure to check with your doctor before you take any type of non-steroidal anti-inflammatory drugs (NSAID).
  • To help reduce and limit swelling, you can wear compression socks or elastic bandages around the injury.

If your superficial hematoma doesn’t seem to be getting better or you think you might have a more serious hematoma, make an appointment to see your doctor.

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When to see a doctor

You might need to see a doctor for X-rays or CT scans if the hematoma is deeper in your body and not readily visible. In some cases, your doctor may also need to surgically drain the hematoma. This would have to be done before the blood begins to clot and turns into a solid mass.

Call your doctor right away if you have any of the following symptoms:

  • Increased pain or warmth at the injury site
  • The hematoma becomes redder or bigger in size
  • You have a fever of 100.4°F or higher
  • Increased inflammation or pain in the extremity (for hematomas on the arm or leg)
  • Hands and/or feet turn blue or become numb and tingly (for hematomas on the arm or leg)

Can hematomas be prevented? 

Some people are more prone to bruising than others. Children are more likely to bruise since they’re more physically active. Older people may bruise more because they have weaker blood vessels that can be damaged more easily.

While bruising is common, you can prevent more serious injuries by simply being more cautious. For example, if you have trouble walking, opt for a walker or cane to lessen your risk of falling and seriously hurting yourself. It can also help to have your vision and hearing checked. 

Complications from hematomas or contusions 

If you notice unexplainable bruises around your body or think you bruise too easily, it could be because of medications you’re taking. Bleeding is the most common side effect of blood thinners (like Aspirin) and anticoagulants (such as heparin or warfarin), but they can also cause bruising. You may also bruise more easily if you have low platelets or other blood disorders like hemophilia and leukemia.

It's rare for easy bruising to be a sign of a serious medical problem, but you should still talk to your doctor to be on the safe side. 

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Medically Reviewed on 5/20/2022
References
SOURCES:

Chemocare: "Bruising (Hematoma)."

Fairview Health: "Hematoma."

healthdirect: "Bumps, knocks and bruises."

Hemaware: "What You Should Know About Hematomas."

Orthoinfo: "Muscle Contusion (Bruise)."

University of Michigan Health: "Concussion Treatment and Recovery."

WVU Medicine: "Bruises: Types and Treatments"