A hematoma is an abnormal accumulation of blood outside a blood vessel. It occurs due to injury to the wall of an artery, vein or capillary.
Types of hematoma
The classification of hematomas depends on their location.
The most dangerous hematomas are those in the head, because this is a closed container and thus the accumulated blood increases the pressure inside.
As a rule, an epidural hematoma occurs due to trauma to the temporal region, which causes injury to the media meningeal artery.
The blood accumulates in the epidural space, which is outside the hard meninges, which lie around the brain like a membrane.
With an epidural hematoma, rapid surgical intervention is indicated.
In a subdural hematoma (between the arachnoid and the hard meninges), there is usually an injury to the cerebral vein.
This leads to slow bleeding and the blood enters the subdural space, under the hard meninges.
There is plenty of room here for blood accumulation before brain damage develops.
The subdural hematomas can:
- be very large,
- Press on the brain,
- To be deadly.
The subdural hematoma can occur on both sides and do not appear until many days after the trauma.
It is most common in patients with chronic diseases.
The intraparenchymal hematoma forms inside the brain tissue.
Intracerebral hematomas can be caused by:
Othämata occurs with an injury that leads to bleeding on the auricle or external ear cartilage.
The blood remains trapped between the thin layer of skin and the cartilage itself.
Since the blood supply to the ear cartilage comes from the overlying skin, a hematoma can reduce blood flow, which can lead to the death of some cartilage areas.
The intramuscular hematoma can be very painful if the bleeding is pronounced.
This can be done with:
- direct trauma,
- Muscle injuries.
The subungual hematoma is the result of a finger or toe contusion on the hand or feet.
The hematoma caused by a subungual hemorrhage occurs under the nail and remains trapped there.
The pressure causes pain.
Over time, the hematoma disappears with nail growth.
Recovery times can be lengthy as the nail grows slowly, which can take up to a few months.
The subcutaneous hematoma is an ecchymosis (bruise). It occurs after trauma, which leads to a violation of the superficial blood vessels under the skin.
The abdominal hematoma can have many different causes.
Regardless of the origin, the result is peritonitis (inflammation of the peritoneum lining the abdominal cavity).
Hematomas can appear in many organs, for example:
- small and large intestine,
Thoracic hematoma is a common complication of chest trauma with possible rib fractures.
Injuries to one or more vessels:
- The chest wall (artery / intercostal vein)
- Of the pleura – when the stump of a broken rib injures the pleura, blood enters the pleural cavity because it has less resistance than the chest wall.
- Parenchyma – hemato-pneumothorax may develop.
- Of the mediastinum (blood vessels of the pulmonary hilus, superior vena cava, aorta and mediastinal vessels) – caused by severe injuries that often lead to death.
- The diaphragm – the muscle is heavily supplied with blood and bleeds easily.
This may be the result of closed chest trauma (bruise or fractures). After severe trauma with severe delay or bruising, the lungs may develop a hematoma, but this rarely happens.
Lung hematoma with flake-like aspect (adjacent picture).
The X-ray of the bruise resembles the picture of pneumonia.
The difference is that in pneumonia, the interstitium and alveoli contain inflammatory fluid, microorganisms and neutrophils, while in pulmonary hematoma, the interstitium and alveoli are filled with blood.
Usually, the hematoma is spontaneously absorbed: the cavity closes, but a linear scar is formed, which persists throughout life.
There are other, less common cases such as:
- After a blood sample, one often sees a hematoma formation in the bend of the elbow, especially in children and the elderly, in which the veins are deeper.
- After tattooing or piercing and with a capillary rupture, a small hematoma can form, which quickly disappears.
- Football players often have a black big toenail as a result of traumas that occur on the football field.
Hematoma on the leg
The hematoma on the leg is a pathology in which a certain area of the lower limb swells due to an accident, for example, a muscle tear, direct trauma (contusion) or disease.
The muscles most affected in athletes are:
- The soleus and gastrocnemius muscle (especially the middle twin muscle) on the calf;
- The rectus femoris of the quadriceps on the thigh;
- The biceps femoris (among the femoral flexors).
Doctors often speak of tear and hematoma in the lumbar region (paraspinal muscles) or abdomen (iliopsoas, pelvis, rectus abdominalis, etc.), but these muscles almost never tear.
In the upper part of the body you can see almost exclusively hematomas due to strains or bruises:
- In the pectoral muscle,
- In the arm flexor muscle.
Symptoms of hematoma on the leg
Symptoms depend on the severity of the injury. However, the clinical picture may worsen if the hematoma is left unnoticed.
Swelling and redness under the skin are the most common symptoms of this leg injury.
Other symptoms of hematoma include:
- pain in the leg and thigh,
- discomfort when walking,
- Sensation of pain.
The affected area turns red. The injured area does not necessarily have to remain red, probably the color varies between black and blue.
Risk factors for hematoma
Hemorrhage, which provokes an accumulation of blood under the skin, is not always tied to trauma.
For example, people prone to bruises show signs of spontaneous hematoma.
The reason is a blood clotting disorder, which can occur due to:
- These drugs prevent the formation of blood clots and can lead to internal bleeding.
- The result is an accumulation of blood all under the skin. Also, people with low platelets (cells that ensure clotting and preventing bleeding) may have a hematoma on their leg.
After an ankle sprain, a hematoma can develop under the ankle bone, in the heel area and up to the toes.
Causes of hematoma on the buttocks are intramuscular injections and occur mainly in the elderly.
Possible complications of muscle hematomas
Many people neglect the treatment of a hematoma on the leg.
But even this can get worse.
If the muscular hematoma is located in a closed and confined fascial space (usually in the front or back of the leg), the pressure can interrupt blood flow in the surrounding tissues.
This disorder is called compartment syndrome and the consequences can be serious:
- muscle necrosis (death of muscle cells),
- rhabdomyolysis (muscle cell rupture and release of substances contained in the blood),
- Loss of a limb.
Diagnosis of muscle hematoma
The superficial hematoma may appear a few days after an injury or deep muscle tear.
To determine the size of the hematoma and effusion, the most common examination is ultrasound.
With a hematoma in the head or internal organs, MRI (magnetic resonance imaging) is required.
Natural remedies for a muscle hematoma
As a rule, hematomas pass on their own.
It is important to keep the affected leg still for the first 2 days, as long as the inflammatory phase is acute.
You can put ice packs on for relief in the first 48 hours:
- put ice cubes in a plastic bag,
- Wrap the ice pack in a towel,
- leave on the affected area for 20 minutes,
- Repeat this 3-4 times a day.
To speed up the healing process, it is necessary to stimulate blood circulation in this area of the leg.
Certainly, hot baths are a quick remedy to promote healing in the injured area.
Applying warming ointments can be helpful for the injury.
Movement exercises improve blood circulation and promote the resorption of the hematoma, recommended is walking:
- 30 minutes in the morning,
- 30 minutes in the evening.
How long does a hematoma last?
A small hematoma (similar to a bruise) passes in about two weeks after changing color from purple to green/yellow.
For larger and deeper hematomas, the healing process is slow and can take several weeks and months.
In even more severe cases, the doctor may advise surgical intervention.
Diet and nutrition for a hematoma
A balanced and nutritious diet is necessary for a speedy healing process.
Fruits and vegetables contain many antioxidants that have anti-inflammatory properties.
Inflammation increases the pressure in the affected area and slows down the healing process.
The affected person should eat foods that contain a high proportion of vitamin C.
Citrus fruits such as oranges, limes and grapefruit are a rich source of vitamin C.
Hematoma after surgical intervention
A hematoma after surgery (or postoperative hematoma) is a local accumulation of blood in the operating area.
Postoperative hematoma is a common complication.
The hematoma can develop after a few hours (or even days) due to injury to the surrounding blood vessels during surgery.
A postoperative hematoma can occur after each procedure, for example:
- Episiotomy (surgical incision in the peritoneum during the birth process);
- Caesarean section;
- cholecystectomy (surgical removal of the gallbladder);
- abdominalplasty (plastic surgery on the abdomen to remove wrinkles and smooth the skin above the stomach);
- Breast augmentation;
Causes of postoperative hematoma
A postoperative hematoma can result from various factors such as:
Human error during surgery
If the patient’s haemostasis (discontinuation of blood loss from a blood vessel) is not effective, bleeding during and after surgery is possible.
If the surgeon is unable to close the blood vessels during surgery, the blood pours into the surrounding tissues, causing a hematoma.
During surgery, it is not always easy to identify injured blood vessels. This is due to:
- contraction of blood vessel walls,
- Gas accumulation in the abdominal cavity.
After surgery, bleeding can be caused by:
- rupture of a blood coagel,
- suture insufficiency,
- Slipping of a surgical clip.
Falls and other activities that are stressful to the wound can cause a hematoma. But even simple things like coughing, sneezing, vomiting, etc. that occur after surgery can cause a hematoma, especially during lifting operations.
The risk of developing a hematoma after surgery is especially high in people taking anticoagulant drugs such as ibuprofen and aspirin. For this reason, patients are asked to stop taking these medications before surgery.
People who perform strenuous activities immediately after surgery have an increased risk of developing a hematoma.
The newborn may develop a hematoma on the sternocleidomastoid (this is the muscle that connects the sternum to the back of the head) a few days after birth.
The cause is a muscle strain during childbirth, especially during a breech birth.
The neck is tilted to one side, so this can also be confused with another disease called myogenic congenital torticollis.
Healing occurs spontaneously and in a short time.
Hypertension or other diseases of the blood can cause a hematoma after surgery.
Symptoms of postoperative hematoma
Usually, symptoms appear within 24 hours, but they can still occur 3 weeks after surgery.
- A feeling of pressure in the operated area,
- Blue or purple discolored outer skin.
Development of a hematoma
With a mild hematoma (ecchymosis), blood loss is minimal and is reabsorbed on its own, this is the natural process.
Within two weeks after hematoma develops, the color of the spot under the skin changes due to hemoglobin transformation.
of the colors of hemoglobin Deoxygenated hemoglobin red-violet hemosiderin blue-green hematoid yellow
What to do? Treatment of hematoma
Doctors recommend physiotherapy treatment to reduce muscle hematoma, a particularly indicated treatment for blood absorption is Tecartherapy.
The Tecar machine is very helpful in preventing the development of an organized hematoma that can form after a muscle tear.
It is a type of hematoma that solidifies over time.
For pain and mild discomfort, doctors may prescribe painkillers such as acetaminophen.
Often with severe pain, a more effective drug is recommended.
Never take aspirin (it is available over the counter) to treat pain caused by a hematoma.
This is because aspirin has an anticoagulant effect and the hematoma can become worse as a result.
The further the blood penetrates into the surrounding tissues, the greater the formation of a blood coagel and the larger the hematoma.
Treatment by heat and cold
Mild cases of hematomas reabsorb spontaneously and do not require surgical intervention. In such situations, therapy with heat or cold is useful to relieve the hematomas.
Ice packs are used for vasoconstriction, which leads to narrowing of blood vessels and reduction of blood flow.
It is important to continue the therapy for two days until the swelling passes.
After that, a warmed towel is placed on the hematoma.
The heat accelerates the healing process because it promotes blood circulation.
It also helps to massage the inflamed area.
Method of drainage
In some cases, a hematoma does not pass after treatment with heat and cold.
In such situations, the surgeon manually drains the accumulation of blood.
He uses a sterile needle to drain the blood by means of aspiration.
Severe cases of postoperative hematoma require surgical intervention, because if left untreated, infections, scars, and eventually necrosis (tissue death) can develop.
A hematoma caused by injury to a main artery is the most dangerous case.
You have to find and close the blood vessel that is causing the problem.
The wound is stitched again.
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