Hematoma can be defined as the collection of blood outside the blood vessels due to rupture or leak in the vessel wall. It usually results from injury to any type of blood vessels such as an artery, vein, or small blood capillary. This leak, though mostly associated with trauma, can also occur due to usage of blood thinners or anticoagulant medications, hereditary bleeding disorders, and also due to our day-to-day activities. Though it sounds terrifying, it is a relatively common process that the body undertakes.
The body repairs damaged blood vessels by allowing the blood that leaked outside the walls to clot which closes the leakage allowing for the normal flow of blood through that vessel. However, the formation of the blood clot puts pressure on the surrounding tissues. The most common symptoms of hematoma are irritation, pain, redness, swelling, and discoloration in the affected area In severe cases, it may lead to loss of consciousness(coma), seizures, loss of vision, or speech.
Causes and Types of Hematoma
The most common cause of hematoma is trauma, but it can also be caused due to aneurysm (enlargement of an artery due to weakness in the wall of the artery), blood thinners, tumors, low platelet count, autoimmune diseases, and bleeding disorders. Given that blood vessels are present in every nook and corner of the body, a hematoma can occur anywhere. The most threatening cases occur inside the skull.
Enclosed within the skull is the brain: any blood leakage would lead to increased intracranial pressure in the skull, thereby impairing the functional ability of the brain. Based on the location of the leak in the space between the skull and the ‘’Dura’’ (the tough outermost membrane enveloping the brain and the spinal cord), two major types of hematomas may occur: epidural and subdural hematomas. Epidural hematomas are usually caused by trauma, leading to a rupture of the middle meningeal artery (present underneath the temporal bone) (1). Blood leaks between the skull and the Dura mater resulting in the formation of mass that presses against the brain tissue, causing a significant increase in pressure in the brain leading to brain injury.
Subdural hematomas involve blood leaking into the subdural space below the Dura caused by a leak in the veins in that region. Unlike epidural hematomas, the subdural region is relatively big and does not allow for blood build-up as quickly as is seen in an epidural region. This means that it is not acute, rather chronic, and the bleeding might stop before showcasing symptoms or causing brain damage. However, large subdural hematomas may be lethal. Besides the two mentioned above, hematomas in other regions of the body are as follows:
- Intracerebral hematomas: occurs within the brain itself and may be associated with uncontrolled high blood pressure, tumor, stroke, et cetera.
- Subarachnoid hematoma: a collection of blood in the subarachnoid space (between the arachnoid membrane and pia mater). It is considered a medical emergency, because it may lead to permanent brain damage or death if not treated in time.
- Scalp hematomas: occurs outside the skull and may look like a bump.
- Intramuscular hematomas: occur within the muscle tissues. This may lead to restriction of blood circulation to the muscles and neighboring tissues leading to permanent damage of the muscles. In such a case, it is considered a surgical emergency.
- Subungual hematomas: occur due to injuries at the toes and fingers and lead to clots formation underneath the nail.
- Subcutaneous hematoma: occurs due to trauma on the superficial blood vessels under the skin.
- Intra-abdominal hematoma: caused due to a variety of injuries or illnesses, involves blood leaking into the abdomen and affecting the functioning of nearby organs (liver, spleen, or kidney).
- Auricular hematoma: collection of blood within the outer ear.
- Septal hematoma: hematoma in the septum of nose.
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Symptoms and Diagnosis
In most cases, hematoma exhibits common symptoms like redness, skin discoloration, tenderness, warmth, pain, and swelling. But there are also cases where it does not show any signs (as in the case of subdural hematoma).
Diagnosis of Hematoma goes a long way and can be the line between life and death. This involves:
A physical examination along with the medical history.
Complete Blood Count test (CBC) to evaluate the underlying reasons for a blood clot.
Computerized tomography (CT) scans for hematoma in the skull or abdomen.
Magnetic resonance imaging (MRI) for epidural hematoma.
The treatment depends on the locations and the symptoms you may exhibit. In mild, cases, no treatment is required or in a few cases, it can be treated at home, whereas others require medical or emergency surgery. For cases like superficial hematoma, following the R.I.C.E procedure, can reduce inflammation and symptoms. The procedure involves:
Ice (applying a cold pack on the affected area to soothe the pain.)
Compress (bandaging affected area)
Elevate (elevating the injured area above the level of the heart is recommended.)
The surgical procedure involves draining the blood from the affected region. This is usually performed in the case of a subdural hematoma; but if the hematoma is small, then it is monitored before going forward with any sort of medical intervention. The surgical process is usually performed in two ways: a craniotomy or a burr hole surgery. A craniotomy means a small part of the skull is temporarily removed to allow the surgeon to operate on the affected area and to remove the hematoma. Once it is removed, the surgeon then places back the removed part of the skull and bolts it down with the help of metal plates or screws.
A craniotomy is an ideal procedure for subdural hematomas that develop immediately after trauma. However, with cases where it develops days after the head injury or trauma, a burr hole procedure is performed. Here, small holes are drilled into the patient’s skull and a flexible tube is inserted in it to drain the hematoma from the skull. This tube may be left in its place for a few days until the hematoma is completely drained out. Both these procedures are performed under general anesthesia but occasionally in some cases of burr hole procedures, they may be performed under local anesthesia which means that the patient would be awake when the procedure is being performed but will not feel any pain as the skull has been numbed.
Given a surgery’s invasive nature, it is no surprise that there may be some complications or risks of complications that may arise. However, instances of it are rare. A few possible complications are further bleeding of the brain, a risk of infection, blood clots in the leg vein, seizure, or a stroke. If no complications arise, recovery is pretty simple and maybe well enough to leave the hospital in a few days after the surgery (2) (3)(4).
Picture Courtesy: wiki.neurotycho.org
1. Healthline Medical Team. Healthline.com. Middle Meningeal Artery. [Online] [Cited: April 27, 2017.] http://www.healthline.com/human-body-maps/middle-meningeal-artery#5/3.
2. N.Nabili, Siamak. Hematoma. RxList.com. [Online] [Cited: April 27, 2017.] http://www.rxlist.com/hematoma/drugs-condition.htm#what.
3. Wedro, Benjamin. Hematoma. MedicineNet.com. [Online] [Cited: April 27, 2017.] http://www.medicinenet.com/hematoma/article.htm.
4. NHS.com. Treating a subdural hematoma. nhs.uk. [Online] [Cited: May 26, 2017.] http://www.nhs.uk/Conditions/Subdural-haematoma/Pages/Treatment.aspx
Does a hematoma need to be drained?
This depends on the location and size of the hematoma. In cases where the hematoma is around sensitive areas like the spine, brain, it will need to be surgically drained. In such sensitive areas, pressure will be applied on the spine or brain, affecting their ability to function normally. This could be fatal if not treated early., hence the choice to surgically drain the hematoma. A very large hematoma that does not resolve by itself will require drainage. This is to avoid unnecessary pressure on the surrounding tissues.