Hematoma

1 What is a hematoma?

A hematoma is a result of an injury to the blood vessels. Consequently, the blood leaks outside into the nearby tissues. In a hematoma, the leaked blood is almost clotted. This is in contrast to a hemorrhage in which the blood is still flowing.

Depending on the degree of the injury, it can be a severe condition with significant inflammation. Or it can be minor with just a dot. In any case, it occurs when the blood clotting mechanism fails to check the bleeding from the damaged blood vessels.

Fatality is largely determined by the degree of damage and its anatomical position in the body. For example, a skin bruise is not usually serious. But even a small hematoma inside the skull can leave disastrous effects on a number of body functions.

2 What are the types of hematoma?

Most often, clinicians categorize hematoma based on the location where the blood accumulates. As a matter of fact, hematoma inside the skull poses a serious risk of death and other complications. It is because any injury inside the skull increases the pressure there. As a result, brain damage is quite likely in such cases.

Hematoma inside the skull includes:

Epidural hematoma: Blood in the space between the dura mater and the skull
Subdural hematoma: Between the inner layer of dura mater and the next brain covering (arachnoid mater)
Intracerebral hematoma: Collection of blood inside the brain tissues

Hematoma outside the skull is not as serious as the ones mentioned above. It is because it has no effect on the brain itself.

Other types of hematoma include:

Subungual hematoma: Blood under the nails on the fingers or toes

Intra-abdominal, peritoneal, or retroperitoneal hematoma: Blood inside the hollow cavity that lies below the diaphragm and above the pelvis

Ear or aural hematoma: A hematoma between the ear cartilage and skin covering it

Splenic hematoma: Blood inside the spleen

Hepatic hematoma: Blood inside the liver tissues

Septal hematoma: Affects the nose

Hematoma within the muscles

3 What is an aural hematoma?

Aural hematoma is a collection of blood in the ear. Specifically, the blood clot develops in the space between the ear cartilage and the skin that covers it. Therefore, it is also referred to as ear hematoma or sometimes auricular hematoma.

Though it is a common occurrence in wrestlers and boxers, anyone can get it. This is after the ear is hit by force. A well-known complication of aural hematoma is what doctors call cauliflower ear. In fact, the name is derived from the appearance of the affected ear that looks similar to cauliflower.

How to treat aural hematoma

Incision and drainage form the mainstay of aural hematoma treatment. However, doctors recommend this only if the occurrence has not gone beyond a week at the time of the visit. In fact, this treatment is contraindicated after 7 days of the injury. For such cases, only a specialist can suggest what’s right for you. 

What are the steps in the aural hematoma treatment procedure?

Before the incision, the doctor will ask you to lay on the side with the unaffected ear.

Then, the doctor will administer a local anesthetic like lidocaine. It causes the loss of sensation in and around the affected areas.

Next, the doctor will cleanse the affected area with an antibacterial solution. In most cases, it is a povidone iodine solution.

In the following step, the doctor will incise the affected skin and remove the hematoma by using suction. Then, the doctor will wash the region and apply a compression dressing.

If there is a risk of an infection, you may also need an antibiotic.

What's the follow-up care for aural hematoma?

Once drainage is over, you will need to be re-examined every 24 hours. This helps to detect if the hematoma has come again.

Do not take Aspirin, any other NSAID medication, or a blood thinner for the next several days. Doing so curbs the risk of bleeding.

Take the recommended antibiotic, if applicable, as per the instructions of your doctor.

If there is a perceived risk of a serious infection, you may need to be admitted to the hospital. In addition, you may also be given an injectable antibiotic.

What to expect

Aural hematoma treatment by incision is successful in most cases. Nevertheless, there is always a chance that it may come again. Consult your doctor about the probable risks and complications of the treatment. 

4 What is subgaleal hematoma?

Subgaleal hematoma is an external head (not brain) injury. In this, blood clots fill the space between the scalp and skull. It is a very rare occurrence. Nonetheless, it carries a considerable risk of a fatal outcome.

This type of closed head injury is most common in newborns. In fact, it is a type of birth trauma. The reason for up to 90% of the cases is the use of vacuum to facilitate delivery.

However, some cases may occur spontaneously as well.

What are the signs of subgaleal hematoma?

The signs of subgaleal hematoma are distinctly visible. It appears as a swampy mass that covers the scalp. It causes a marked increase in the head circumference. Also, there may be a sign of skin bruising in the scalp, eyes, and ears.

Typically, 12 to 72 hours after delivery of the newborn, the swelling becomes noticeable. However, some severe cases may be visible right after the birth. When you change the position of the baby, the swelling also tends to shift accordingly.

In other cases, you may be notice abnormal eyes. They are known as raccoon eyes or panda eyes. This condition warrants urgent medical care.

Seizures may occur due to increased pressure inside the head.

Complications of subgaleal hematoma

Death is the most serious complication of subgaleal hematoma. It may take place due to a severe loss of blood. Consequently, the heart fails to pump enough blood to vital organs.

Moreover, death may also ensue due to the loss of various brain functions. With timely treatment, most cases resolve almost completely and have no residual effects.

Another equally dangerous complication in subgaleal hematoma patients is disseminated intravascular coagulopathy (DIC). It causes an overactivation of the molecules involved in blood clotting. As a result, blood clots spread throughout the body.

On the other hand, DIC may also result in excessive bleeding. In fact, it may occur even without an injury.

It is a very serious disorder that needs immediate medical attention.

What is involved in subgaleal hematoma treatment?

Quite often, it takes more intense therapy to treat subgaleal hematoma. Treatments may include:

  • Fluids to restore the fluid volume and treat shock. This prevents damages to vital organs
  • Anti-seizure medication to control seizure activity
  • Bicarbonate if the blood pH is very low (acidosis)
  • Medications that increase heart contractions
  • CT scan to evaluate the characteristics of the hematoma

5 What are the causes of a hematoma?

In most cases, a hematoma results due to an injury to the blood vessels. In addition, other medical conditions, medications or diseases affecting blood clotting mechanisms can also be the culprit.

Here is a brief description on how certain conditions may lead to a hematoma:

Injury: Blood vessel injury is an aftereffect of a strong impact on their walls. As a result, they tear and the blood inside them flows into the surrounding tissues. Over time, the leaked blood clots results in a swollen mass. If it is small, your body may be able to repair it on its own.

Other medical conditions such as aneurysms: An aneurysm is an abnormal protrusion of the weaker portion of the blood vessel. The weaker portion bulges as it cannot withstand the pressure of the blood inside. Not all aneurysms are harmful. In fact, you may not be able to notice their effects even once in your lifetime. Nonetheless, some can be potentially dangerous. This is especially true if they rupture. For example, rupture of a brain aneurysm may lead to death. Aortic aneurysm occurs when one section of the body’s main blood vessel aorta bulges out. According to the Centers for Disease Control and Prevention (CDC), it is the direct or indirect reason for the death of 25,000 Americans annually.

Blood thinners: These medications decrease the coagulability of the blood. They do so by interfering with the functions of clotting factors and platelets. As a result, there is a risk of spontaneous bleeding. This is more common in the patients who have to use any of these medications for a long time. For example, warfarin (Coumadin), aspirin, clopidogrel (Plavix), prasugrel (Effient), rivaroxaban (Xarelto), and apixaban (Eliquis) are blood thinners.

Diseases that decrease platelet count or affect their function: Platelets help to form blood clots immediately after bleeding starts. Understandably, dysfunctional platelet activity delays clotting. Some causes of this include vitamin D deficiency, bacterial or viral infections, and certain types of anemia.

Bone fractures: Bones store a spongy tissue that produces blood cells. It is called bone marrow. When a bone is broken, you lose a substantial amount of bone marrow. As result, the risk of hematoma formation rises.

Bleeding disorders: Your blood cannot clot normally if you have disorders like hemophilia or Von Willebrand disease.

Moreover, pregnancy, delivery, and menstruation are natural causes of hematoma. However, you should not take bleeding during pregnancy too lightly. Instead, seek immediate medical attention.

Supplements like Ginkgo Biloba, garlic, and Vit E also increase the risk.

6 What are the signs and symptoms of a hematoma?

Pain, inflammation, bruises, and a red appearance at the affected site are general signs. However, if the hematoma is inside the organs or skull, not all these signs will be present.

Here are some signs specific to its location.

Subdural hematoma: Headache, mental confusion, weakness on one side of the body, and convulsions.

Epidural hematoma: Back pain, inability to control urination or bowel movements.

Subungual hematoma: Painful and discolored nail

Hematoma inside the skull or internal organs can be potentially life-threatening. Therefore, watch for the following signs if you had a recent bump on your head, fall, or any other high-impact injury.

  • Difficulty maintaining balance
  • Confusion
  • Vision problems like double vision
  • Excessive tiredness
  • Increased sensitivity to light or noise
  • Memory problems
  • Problems with focus

Seek emergency medical help if you develop any of the following symptoms:

  • Unequal pupil size
  • Drainage from the nose, mouth, or ears
  • Seizures
  • Abnormal facial appearance
  • Bruises on the face
  • Skull fracture
  • Changes in vision, taste, or smell
  • Paralysis or weakness of the limbs
  • Mood changes
  • Fainting
  • Decreased breathing
  • Extreme agitation
  • Severe headache
  • Problem with speaking
  • Severe and persistent vomiting

7 Home remedies for hematoma

Of course, some simple measures may give you a relief and/or boost recovery rate. The home remedies for hematoma are conventional in nature. In fact, they do not cure it. Also, be sure not to rely only on these when your condition is serious.

Consider one or more of the following:

RICE (Rest, Ice, Compression, Elevation)

Immobilization of the affected part. Remember this may not be always possible or effective. It depends on the affected area.

Take OTC pain medications to relieve pain and reduce swelling. However, all these medications may not be suitable for a patient who is on taking a blood thinner. In addition, paracetamol may not be a good choice for a patient with liver problems. If this concerns you, talk to your doctor or pharmacist. They may switch to other medications or ask you to reduce the dose.

8 How to prevent hematoma

Unfortunately, no measure can fully protect you from a hematoma. Accidents happen and injuries are an indispensable part of them. Nevertheless, a few measures may reduce its risk by a huge margin. Consider the following if it suits you:

  • Wear protective gear properly. This is especially important if you participate in contact sports on a regular basis.
  • Avoid participating in sports/activities with a high risk of injury.
  • If you are taking a blood thinner for any other condition, take extra precaution. For example, get routine testing to monitor the coagulability of your blood.
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