What is a bruise or a hematoma?

Although bruises and hematomas may present similarly, they are different conditions.

A bruise, also known as a contusion, typically appears on the skin after trauma such as a blow to the body. It occurs when the small veins and capillaries under the skin break.

A hematoma is a collection (or pooling) of blood outside the blood vessel. Hematomas are classified as subdural, spinal, subungual (under the finder or toenail bed) or hepatic (liver).

Causes of bruise or hematoma

Causes of a bruise

  • Accidents or bumps
  • Microscopic tears in the blood vessels under the skin in athletic people
  • Bleeding disorders — unexplained bleeding that occurs without reason
  • Thinner skin due to aging

Causes of a hematoma

Trauma is the primary cause of a hematoma. Trauma can be the result of a car accident, fall, broken bones, gunshot wound or head injury.

Hematomas may also be caused by:

  • Aneurysm
  • Certain medications
  • Viral infections such as rubella, mumps, chickenpox, HIV or hepatitis C
  • Orthopedic injuries such as fractures

Risk factors for bruise or hematoma

Risk factors for a bruise

People who have any of the following factors are at higher risk for developing a bruise.

  • Vitamin C deficiency
  • Bleeding disorders
  • Patients who take anticoagulants (blood thinners)

Risk factors for a hematoma

  • Older age
  • Anticoagulant (blood thinner) usage
  • Recent trauma

Symptoms of bruise or hematoma

Symptoms of a bruise

  • Dark blue or purple patch of skin that appears within a few hours after injury
  • Tenderness on or around the affected area

Symptoms of a hematoma

  • Inflammation
  • Redness
  • Tenderness
  • Warmth
  • Pain
  • Swelling

Diagnosis of bruise or hematoma

Diagnosing a bruise

Most people can self-diagnose a mild bruise after evaluating the signs or symptoms.

If you have a severe bruise and suspect you may have more serious injuries, your doctor may order an x-ray of the area to ensure you do not have broken bones.

If you have frequent bruising, your primary care doctor may order a blood test to check for a bleeding disorder.

Diagnosing a hematoma

If the hematoma symptoms are severe or if it continues to expand over the course of a few days, you should visit your doctor right away. Emergency medicine, urgent care, primary care physicians frequently care for patients with hematomas.

A primary care doctor can diagnose a soft tissue hematoma in a physical exam. If you are experiencing more serious symptoms, your doctor may order any of the following diagnostic tests:

  • X-ray — to diagnose bone fractures
  • CT scan — to diagnose head injuries
  • Ultrasound — for pregnant patients

Treatment for a bruise or a hematoma

Treatment should begin as quickly as possible after injury. First-line therapy is rest, ice, compression and elevation (RICE method). If the injured area is painful, the injury can be treated with OTC medications like Tylenol or Advil.

If you have a hematoma that involves other organs in the body, your treatment will be tailored to your situation.

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