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Medical Author:

Benjamin Wedro, MD, FACEP, FAAEM

Benjamin Wedro, MD, FACEP, FAAEM

Dr. Ben Wedro practices emergency medicine at Gundersen Clinic, a regional trauma center in La Crosse, Wisconsin. His background includes undergraduate and medical studies at the University of Alberta, a Family Practice internship at Queen's University in Kingston, Ontario and residency training in Emergency Medicine at the University of Oklahoma Health Sciences Center.

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Medical Editor:

Charles Patrick Davis, MD, PhD

Charles Patrick Davis, MD, PhD

Dr. Charles "Pat" Davis, MD, PhD, is a board certified Emergency Medicine doctor who currently practices as a consultant and staff member for hospitals. He has a PhD in Microbiology (UT at Austin), and the MD (Univ. Texas Medical Branch, Galveston). He is a Clinical Professor (retired) in the Division of Emergency Medicine, UT Health Science Center at San Antonio, and has been the Chief of Emergency Medicine at UT Medical Branch and at UTHSCSA with over 250 publications.

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Hematomas cause irritation and inflammation. Symptoms depend upon their location and whether the size of the hematoma or the associated swelling and inflammation causes nearby structures to be affected. The common symptoms of inflammation include redness, pain, and swelling.

Hematomas tend to resolve over time.

• The initial firm texture of the blood clot gradually becomes more spongy and soft as the clot is broken down by the body.
• The shape changes as the fluid drains away and the hematoma flattens.
• The color changes from that of a purplish-blue bruise to yellows and browns as the blood chemicals gradually are removed and the hematoma resolves.

Depending upon its location, the discolorations may travel through different tissue planes by gravity. For example, a forehead hematoma may cause bruising beneath the eyes and seem to travel to the neck as it resolves over time. However, there are specific situations that may occur with hematomas in various parts of the body that show symptoms that are unique to the location of the hematomas. They are listed below.

Hematomas may occur commonly and have little importance while others are life-threatening. Many times it is a matter of location and situation that makes the hematoma a critical condition instead of an inconvenience.

Hematoma in Menstruating or Pregnant Women

For example, in women, during menstruation small blood clots may be passed from the vagina as the uterus empties itself as part of the normal menstrual cycle.

Bleeding in pregnancy is never normal except for a short time after the baby is born. In the first trimester, vaginal bleeding may indicate that there is a threatened miscarriage and should prompt the expectant mother to seek medical care. Not all bleeding leads to a miscarriage and many pregnancies may continue to full term with a normal baby.

Bleeding near term may an indication of a major obstetrical emergency and medical care should be accessed immediately. The two worrisome conditions in third trimester bleeding include placenta previa and placental abruption. Placenta previa describes the situation where the placenta covers the uterus and blocks the baby's path from leaving the uterus. As the cervix dilates, blood vessels within the placenta are stretched and torn and cause painless vaginal bleeding. Abruption describes a situation where the placenta prematurely separates from the uterus wall and decreases the ability to transfer oxygen rich blood to the fetus. Placental abruption usually causes significant pain.

Hematomas of the Head

Intracranial hematomas describe blood clots that occur within the skull. These clots affect brain function because any bleeding or swelling may cause increased pressure to build within the closed space of the bony skull. The increased pressure squeezes the brain and causes it to stop functioning appropriately. Symptoms may include nausea, vomiting, headache, and mental alterations. Intracranial hematomas are named based upon where they are located, either within the brain, the tissues that line the brain, or in the spaces that bathe the brain in fluid (CSF=cerebrospinal fluid).

• Epidural hematomas occur in the epidural space, outside the dura lining of the brain. These hematomas often occur due to trauma and associated tearing of arteries that line the inside of the skull supplying the brain with blood. Because of the way the dura is attached to the skull, small amounts of blood can cause significant increases in pressure and brain injury.
• Subdural hematomas occur because of trauma and damage to the veins that line the brain. This causes a slower leak of blood into the subdural space. The space below the dura has much more room in it and more blood can be tolerated before brain function suffers. As people age, they lose some brain tissue and the subdural space is relatively larger. The bleeding into the subdural space may be very slow, gradually stop and not cause acute symptoms. These chronic subdural hematomas are often found incidentally on computerized tomography (CT) scans as part of an evaluation for confusion or because another traumatic incident occurred.
• Intracerebral (intra= within + cerebrum=brain) hematomas are blood clots that are located within the brain tissue itself. They may be due to bleeding from uncontrolled high blood pressure, an aneurysm leak or rupture, trauma, tumor or stroke.
• Subarachnoid hemorrhage is another type of intracerebral bleeding where blood leaks from an aneurysm into the subarachnoid space causing symptoms like intense headache, neck stiffness, and vomiting. Blood within this space may clot or form a hematoma preventing the normal circulation and drainage of cerebrospinal fluid or CSF (the fluid that bathes and provides nutrition to the brain). Hydrocephalus describes this condition. Some intracerebral hematomas will also leak into the subarachnoid space
• Scalp hematomas occur on the outside of the skull between the bone and the skin of the scalp. There are numerous layers to the scalp and the hematoma may be located in any of those layers. While a scalp hematoma cannot press on the brain and cause symptoms, it is a signal that a head injury has occurred and there may also be underlying brain injury. This is especially true for neonates and infants.

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