Geriatrician Questions Geriatrician

Bruised leg?

I walked into the corner of a table and severely hurt my thigh to the point that I was unable to walk. Though painful, the next day I could walk but noticed no bruise in the thigh area and I normally bruise very easily so I was surprised. By the next day though, my knee started to swell and show bruising. Still, no bruise on the thigh which was still painful but no pain elsewhere. The bruising continued down the front and around to the back of my entire leg to the ankle. After a week and seeing the bruising growing (still nothing on the thigh) I went to urgent care and had an X-ray and sonogram but no one could tell me why this was happening. I was taking a baby aspirin daily so I was told it could be because of that and my age-related thin skin. I’ve never seen anything like this and wonder what could have caused such severe bruising.

Female | 74 years old
Complaint duration: 2 weeks
Medications: Artorvastatin, hydrochlorothiazide, lexipro, yearly euflexa injections for knees
Conditions: Arthritis in both knees

3 Answers

You actually had a thigh bruise - it was just "deep" - far enough below the skin that it was "invisible". Bruising is nothing more than a hematoma - bang your thigh - blood vessels break - they bleed - and form a "bruise". Your thigh had a bruise where you hit it. But it was deep underground. However gravity took that blood - and exerted its effects. Blood started moving down the tissue planes - and became more "visible" Often I will tell people who have a large forehead hematoma, to expect a black eye in 2-3 days - because the blood will "sink" down to that area. Your blood in the thigh hematoma just moved down your leg. Nothing to do - it will go away after a couple weeks (some people faster, older we get the slower). Heating pad can help with stiffness! Rarely hematomas can get infected (fever and pain) or become dangerously large (almost always only in those people on blood thinners).
You have something we call defuse traumatic ecchymosis - several bruising for short. The main reason is bleeding, secondary to trauma. It's not unusual in patients on blood thinners or antiplatelets such as aspirin for the bruising and swelling to worsen before getting better.
The injury produced tissue bleeding at the thigh that was too deep to see. Aspirin permits the bleeding to continue longer than usual, though seldom dangerously. Simple gravity caused painless bruising to appear distal to injury site. The bruising will resolve. The injury site itself also will most likely resolve, but should be evaluated if pain persists more than a few weeks. If you take aspirin for an important preventive purpose, this not a good reason to stop it.