Hematoma vs. Bruise: Causes, Symptoms, Pictures & Treatment (original) (raw)
- Introduction
- Causes/Risk Factors
- Signs/Symptoms
- When to See a Doctor
- Specialists
- Diagnosis
- Treatment
- Prognosis
- Prevention
- FAQs
What is a hematoma? What is a bruise?
A hematoma may have no visible signs, but a bruise will appear as localized discoloration.
A hematoma is a localized collection of blood in the tissues of the body outside of the blood vessels.
Also called a contusion or "black and blue mark," a bruise is a discoloration of the skin that is a result of leakage of blood from capillaries into the skin.
Is a hematoma a bruise?
A hematoma and a bruise (also known as a contusion) are related but not exactly the same. To determine whether an injury is a hematoma or a bruise, consider the following:
- Appearance and size: Hematomas are generally larger and may appear as a bulge or swelling, while bruises are typically flat against the skin surface.
- Symptoms: If there is significant pain, swelling, and warmth in addition to discoloration, this may indicate a hematoma rather than a simple bruise.
- Duration and healing: Bruises often heal within a few weeks, changing color as they do. Hematomas may take longer to resolve and can sometimes require medical intervention if they do not improve or if they worsen over time.
- Location: The location of the injury can also provide clues. For instance, a hematoma may occur in deeper tissues or organs, while bruises are usually visible on the skin surface.
While both hematomas and bruises involve bleeding under the skin, they differ in their severity, causes, and symptoms. If there is uncertainty about the nature of an injury, especially if it is accompanied by severe symptoms, it is advisable to seek medical attention.
Hematoma vs. contusion
A hematoma is a collection of blood in the tissues, while a contusion is a bruise of the skin. Both are caused by trauma, but hematomas can occur in any soft tissue, while contusions are limited to the skin's surface.
The table below summarizes the difference between a hematoma and contusion:
| Feature | Hematoma | Contusion or Bruise |
|---|---|---|
| Definition | A localized collection of blood outside the blood vessels, usually in liquid form within the tissue | Discoloration of the skin from bleeding under the skin |
| Appearance | Swelling with a more defined and sometimes raised area; may appear dark red or purple | Discolored skin (black, blue, purple, or yellow) without any significant swelling or a raised area |
| Cause | Trauma, surgery, or a ruptured blood vessel leading to blood pooling outside the vessel | Blunt force trauma that causes capillaries or small blood vessels to break and leak blood into surrounding tissues |
| Location | Can occur in any part of the body, including muscles, organs, and the brain | Typically occurs just under the skin |
| Pain | Can be painful due to pressure from the accumulated blood | Usually painful but less severe than hematomas; however, associated injuries may cause pain |
| Severity | Can be severe, especially if located in critical areas (such as the brain) | Usually less severe, with pain and discoloration resolving over time |
| Complications | May require medical intervention to drain the blood and relieve pressure | Generally heals without medical intervention, though severe contusions may need treatment |
| Treatment | Rest, ice, compression, elevation (RICE) for certain locations; in severe cases, surgical drainage may be necessary; pain relief medications if needed | Rest, ice, compression, elevation (RICE) for bruises associated with injuries in certain locations; pain relief if needed |
| Healing time | Weeks to months, depending on size and location | Typically heals within a few days to a couple of weeks |
What are the causes and risk factors for bruises and hematomas?
Bruises and hematomas most commonly result from injury to the tissues. The tissue injury may be mild or severe.
Risk factors for developing bruises or hematomas include:
- Contact sports (including soccer, football, basketball, rugby, lacrosse, and others)
- Gardening
- Slipping, falling, and tripping; having medical conditions that affect balance
- Abnormal compression on the skin
- Hypodermic needle injections
- Blood drawing
- Cupping treatments
- Blood-thinning medications (aspirin, warfarin/Coumadin)
- Conditions or diseases resulting in a diminished ability to clot blood properly (thrombocytopenia, bone marrow diseases, von Willebrand disease, and others)
The conditions that cause severe inability to clot blood properly (thrombocytopenia, bone marrow diseases, von Willebrand disease, and others) can cause spontaneous bruising and hematomas without tissue injury from trauma.
Bruising occurs more commonly with aging, especially with a significant history of repeated sun damage to the skin.
What are the signs and symptoms of a hematoma or a bruise?
Hematoma symptoms
Hematomas may or may not be associated with symptoms, such as localized pain and tenderness. Because a hematoma often does not directly involve the skin, it may not have any visible appearance or may be associated with a tender raised area under the skin. If the hematoma is in an internal organ, it will not be visible. If a hematoma seriously affects an organ, that organ may have impaired function. For example, a hematoma in the brain can cause paralysis; a hematoma in the kidney may cause decreased kidney function.
Bruise symptoms
A bruise will always appear on the skin as a localized area of discoloration. Initially, a bruise may appear bluish, blackish-blue, or purple. Eventually, its color usually evolves to brownish, then light green as it fades. A bruise may or may not be tender. A typical sign of a bruise on the skin is that it does not blanch when pressed. Sometimes bruises are associated with tears in the skin.
When to seek medical care for a hematoma or bruise
Seek medical care for any hematoma or spontaneous bruising that occurs without any known cause, so a health care professional can determine whether you have a serious underlying medical condition.
Both minor hematomas and bruising are common results of activities from daily living and usually require no specific treatment, other than avoiding reinjury.
When should you worry about a hematoma? Have a health care professional evaluate hematomas or bruises that are causing persisting pain or diminished function.
What specialists diagnose and treat hematomas and bruises?
All general medicine and family medicine specialists treat hematomas and bruises.
Other health care professionals who treat hematomas and bruises include:
- Urgent care specialists
- Emergency room doctors
- General surgeons
- Neurosurgeons
- Dermatologists
- Nurse practitioners and nurses
- Internal medicine specialists
- Pediatricians
The specialists who are involved with treating hematomas and bruising often depend on associated symptoms and whether internal organs have an injury.
How do doctors diagnose hematomas and bruises?
Doctors can often diagnose hematomas located in the tissues just beneath the skin in the office during the history and physical examination. Swelling or tenderness in a local area can indicate a hematoma. Hematomas deeper in the body and organs, such as the brain or spleen, can require radiologic imaging tests to detect them. These tests include CT scans, MRI scans, and others.
Doctors diagnose bruises clinically during the history and physical examination based on the characteristic discolored, non-blanching appearance of the skin.
QUESTION Emotional trauma is best described as a psychological response to a deeply distressing or life-threatening experience. See Answer What are the treatments for hematomas and bruises?
Hematoma treatment
Hematomas may not require any specific treatment, and the body eventually will biologically resorb the collection of blood over time. Initial treatment of a superficial hematoma can include cold compression. Later treatment, after bleeding (hemorrhaging) has stopped, may include warm compresses to help reabsorb the blood in the tissues.
Serious hematomas, especially those affecting organs, can require surgical drainage to relieve pressure on the injured tissues. Occasionally, superficial hematomas under the skin can leave a fluid-filled sac, referred to as a seroma, after the body has biologically resorbed the blood. Seromas can also require a drainage procedure, either with a needle and syringe or via surgical operation.
Bruise treatment
Bruises only require avoiding reinjury and protection of the involved skin. If there are associated skin tears, you can use topical antibiotics and a bandage.
What is the prognosis for hematoma and bruise?
The prognosis for hematomas and bruises is usually good. How do you know if a bruise is serious? The prognosis can be serious if internal organs are injured or if the hematoma or bruising occurs spontaneously without injury, as this can represent a serious underlying medical condition.
How to prevent hematoma and bruise
To prevent hematomas and bruises, avoid physical trauma. Take precautions during activities and use appropriate protective gear as needed. Make sure your surroundings are safe by removing risks, handle objects with care, and be mindful of medications that can increase bleeding risks.
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Frequently asked questions
- What do you do for a bruise that won’t go away? To manage a persistent bruise, rest and protect the affected area to avoid further trauma. Apply ice packs for 15-20 minutes several times daily during the first 48 hours to reduce swelling. Use a compression bandage and elevate the bruised area above heart level when possible. Over-the-counter pain relievers such as acetaminophen or ibuprofen can help alleviate discomfort. If the bruise remains for more than two weeks, is unusually large, or is accompanied by severe pain, consult a doctor for further evaluation, as it could be a sign of an underlying health condition.
- How do bruises go away? Bruises heal naturally as the body reabsorbs trapped blood under the skin. The process begins with inflammation, during which blood vessels constrict and white blood cells clear debris. Subsequently, tissue and collagen repair ensue, followed by remodeling as hemoglobin breaks down, causing the bruise to change color and eventually fade. This typically takes about two weeks. If bruising occurs frequently or without explanation, it's advisable to seek medical attention.
- What does a hematoma look like after a blood draw? After a blood draw, a hematoma appears as a swollen area filled with blood, typically characterized by discoloration under the skin. Initially, it may look dark blue or purple, resembling a bruise. As it heals, the color changes to green or yellow before fading completely over several days to weeks.
Medically Reviewed on 8/8/2024
References
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