What is Hematoma?
Hematoma is a pathological condition in which there is collection of blood outside the blood vessels. Hematoma is usually caused due to an injury or damage to the walls of a blood vessel resulting in the blood to come out of the blood vessel into the surrounding tissues. Hematoma can be caused due to any injury or damage to the blood vessel whether it be an artery, vein, or even a small capillary.
Hematoma is quite a common condition and everyone at some point in their lives suffer from this condition. Hematoma can be most commonly seen under the nails as bluish discoloration when there is an injury to the finger, especially a crush injury. Hematoma is a benign condition and usually resolves on its own with time as the debris is removed and the damaged blood vessel is repaired by the body’s internal repair mechanism. However, in some cases especially when there is a hematoma developed in the brain or in other sensitive areas of the body then such Hematomas need to be surgically removed.
What are the Different Types of Hematoma?
Hematoma which occur on the surface of the skin are clearly visible and go away with time but some hematomas that are formed internally are not visible and they may go on to form a lump or a clot. These hematomas are named based on the basis of their location. These types of hematomas are:
Subdural Hematoma: This type of Hematoma develops between the brain tissue and the inner lining of the brain
Spinal Epidural Hematoma: This type of Hematoma develops between the spinal vertebrae and the outer lining of the spinal cord
Intracranial Epidural Hematoma: This type of Hematoma develops between the skull and the outer lining of the brain
Subungual Hematoma: This type of Hematoma is found under the nail and is seen as a bluish discoloration and occurs as a result of a crush injury to the finger.
Splenic Hematoma: This type of Hematoma develops in the spleen
Hepatic Hematoma: This type of hematoma develops within the liver.
What are the Causes of Hematoma?
Injury or trauma causing damage to the blood vessels is the primary cause for development of a Hematoma. This damage or injury can disrupt the lining of the wall of the blood vessel. Even a little bit of damage to the wall of the blood vessel may result in blood seeping out from the vessel and resulting in development of a Hematoma.
Major Hematomas like that in the brain or the spinal cord are usually caused due to high impact motor vehicle collisions which can result in intense internal bleeding causing formation of a Hematoma. Hematoma can also be caused as a result of surgery like an incision & drainage, biopsies, or any root canal procedure done. This is because the procedure itself may damage surrounding tissues and vessels resulting in formation of a Hematoma.
In some cases, Hematoma is formed without any known etiology or any history of trauma. People who are on blood thinners are at an increased risk for formation of hematoma. These medications are Coumadin, Plavix, and aspirin. This is because blood thinners impair the ability of the body to clot the blood and hence even if there is a minor injury to the vessel bleeding may be difficult to stop and repair of the vessel becomes difficult.
Some of the medications which may increase chances of formation of Hematoma are:
- Vitamin E
- Garlic supplements
There are also certain medical conditions which may cause formation of Hematoma. These medical conditions are:
- Chronic liver dysfunction
- Alcohol abuse
- Bleeding disorders like hemophilia
What are the Symptoms of Hematoma?
Some of the generalized symptoms of Hematoma are pain, swelling, erythema, presence of a significant bruise at the site of the injury but normally symptoms for Hematoma depend on the location of the Hematoma and include:
- Symptoms of Subdural Hematoma: For cases of subdural hematoma, the symptoms may include persistent headaches, confusion, altered mental status, problems speaking clearly, weakness on one side of the body, and in some cases seizures
- Epidural Hematoma: Symptoms of epidural hematoma include persistent back pain, weakness, loss of bowel and bladder function
- Subungual Hematoma: Symptoms of subungual hematoma include discolored nail, pain in the nail, loss of nail
- Symptoms of Hematoma within the abdominal area that is within the spleen or liver include severe and persistent abdominal pain and flank pain.
In some cases even a large hematoma may not produce any symptoms and may be an incidental finding on radiological studies done for some other condition. This is seen in cases of Hematoma in the abdominal region where there is enough space for the hematoma to expand before the onset of any symptoms whereas in cases such as a subdural hematoma where there is much less space for the hematoma to expand there will be symptoms experienced even if the size of the hematoma is quite small.
How is Hematoma Diagnosed?
If an individual is suspected to have a Hematoma, then the treating physician will begin by taking a brief history of the patient inquiring as to when the symptoms started, if there is any history of an injury or trauma to the area. In case if a hematoma is suspected in the brain then the physician will refer the patient to a neurologist or neurosurgeon which will examine the patient and order studies like an MRI or a CT scan of the head to pinpoint the location of the Hematoma and then formulate a treatment plan. In cases where a Hematoma is suspected in the abdominal region then blood tests may be done along with a chemistry panel and liver function tests to identify the cause of the Hematoma. Radiological studies with MRI and CT scans will then be conducted to pinpoint the exact location of the Hematoma and then formulate a treatment plan best suited for the patient.
What is the Treatment for Hematoma?
For small Hematomas that do not cause any symptoms there is not specific treatment formulated and the hematoma is just monitored periodically through imaging studies to see if it is growing in size or not. For cases of Hematomas in the brain, surgical procedure will be recommended for draining of the Hematoma as an enlarging Hematoma in the brain may start to compress other structures of the brain and pose quite serious problems for the patient. In cases if Hematoma is caused by a blood thinning medication, then consultation with the physician to adjust the dosage is enough to treat the Hematoma. Hematomas suspected to be caused due to some underlying medical conditions can be treated by treating the underlying cause. Pain caused due to Hematoma can be treated with pain medications, although NSAIDs may be contraindicated in such cases as it poses a risk for increasing the formation of Hematoma.
For hematomas in the brain, the surgical procedure of choice is surgical drainage of the hematoma. The urgency of the procedure and the approach to the procedure will be dictated by the size and the exact location of the Hematoma.
What is the Prognosis for Hematoma?
The overall prognosis of Hematoma is quite good as minor hematomas resolve on their own without any treatments. Prognosis for Hematoma located in the brain is somewhat guarded as during draining of the hematoma certain structures of the brain may get damaged causing permanent or temporary disability for the individual. For all other cases, the prognosis is pretty good for people suffering from Hematoma.