Contusion vs. Hematoma: What's the Difference?
A hematoma is a collection of blood outside a blood vessel. A contusion is a type of hematoma.
The definition of a contusion is a bruise, which occurs when blood vessels are damaged or broken as the result of an injury. Blood leaks from the damaged blood vessels into the surrounding tissues causing them to turn a purplish color. A bruise may be accompanied by a raised area or bump.
A bone contusion is a bruise on the bone that can occur on any bone in the body (chest, rib, knee, head, leg, etc.). It is less serious than a fracture, and symptoms may include swelling and stiffness of a joint, pain and tenderness in the injured area, and difficulty using the injured joint.
A hematoma is a collection of clotted blood outside of a blood vessel that occurs when the wall of a blood vessel has been injured and leaks into surrounding tissues. Symptoms of a hematoma may include pain, swelling, inflammation, and redness.
Hematomas may be described based on their location. Some types of hematomas include:
- subdural hematoma – forms outside the brain
- subdermal hematoma – bruise under the skin
- epidural hematoma – blood collects between the skull and the protective membrane covering the brain
- subchorionic hematoma – occurs during pregnancy; blood collects between the uterus and the gestational membranes, such as the placenta
- subungual hematoma – blood collects under the finger or toenail bed
What Are the Symptoms of Hematomas vs. Contusions?
Hematomas cause irritation and inflammation. Symptoms of a hematoma depend upon their location, and whether the size of the hematoma or the associated swelling and inflammation cause nearby structures to be affected.
The common symptoms of inflammation from hematoma include:
- pain, and
Bruises can be associated with tenderness of the involved discolored area. Bruises change in appearance over time, and it may be possible to tell by looking at a bruise how old it is. When it first appears, a bruise will be reddish looking, reflecting the color of the blood in the skin. By one to two days, the reddish iron from the blood undergoes a change and the bruise will appear blue or purple. By day six, the color changes to green and by day eight to nine, the bruise will appear yellowish-brown. In general, the bruised area will be repaired by the body in two to three weeks after which the skin will return to normal.
What Causes Hematomas vs. Contusions?
Trauma is the most common cause of a hematoma. When people think of trauma, they generally think of car accidents, falls, head injuries, broken bones, and gunshot wounds. Trauma to tissue also may be caused by an aggressive sneeze or an unexpected twist of an arm or leg. When a blood vessel is damaged, blood leaks into the surrounding tissue; this blood tends to coagulate or clot. The greater the amount of bleeding that occurs, the larger the amount of clot (hematoma) formation.
Medications: Blood thinners or anticoagulation medications, including warfarin (Coumadin), aspirin, clopidogrel (Plavix), prasugrel (Effient), rivaroxaban (Xarelto), and apixaban (Eliquis) may increase the potential for spontaneous bleeding and for hematomas to expand because the body cannot efficiently repair blood vessels. This allows blood to continually leak through the damaged areas.
Diseases or conditions that may decrease the number of platelets in the bloodstream (thrombocytopenia) or diminish their function:
- Viral infections
- aplastic anemia,
- cancers from other organs,
- long-term alcohol abuse, and
- vitamin D deficiency.
- Orthopedic injuries: Fractures are always associated with hematomas at the fracture site.
- Pelvic bone fractures: These breaks can also bleed significantly since it takes a large amount of force to break these bones and nearby veins and arteries also are frequently damaged.
- Menstruation: During menstruation, blood can accumulate in the vagina as part of the normal menses and, instead of flowing out immediately, it may form small blood clots.
- Pregnancy: Vaginal bleeding and passing blood clots or hematomas while pregnant are not normal and are reasons to seek immediate medical attention.
- Labor and delivery: Passing blood clots after delivering a baby is relatively common.
A bruise is caused when tiny blood vessels are damaged or broken as the result of trauma to the skin (be it bumping against something or hitting yourself with a hammer). The raised area of a bump or bruise results from blood leaking from these injured blood vessels into the tissues as well as from the body's response to the injury. A bruise is medically referred to as a contusion. A purplish, flat bruise that occurs when blood leaks out into the top layers of skin is referred to as an ecchymosis.
The injury required to produce a bruise varies with age. Bruising occurs more easily in the elderly because their capillaries are more fragile than those of young people. While it may take quite a bit of force to cause a bruise in a young child, even minor bumps and scrapes may cause extensive bruising in an elderly person. Blood vessels become more fragile as we age, and bruising may even occur without prior injury in the elderly.
The amount of bruising may also be affected by medications which interfere with blood clotting (and thus cause more bleeding into the skin or tissues).
Patients with inherited clotting problems (such as in hemophilia) or acquired clotting problems (such as in patients with liver diseases like cirrhosis) can develop extensive bruising, unexplained bruising, or even life-threatening bleeding.
What Is the Treatment for Hematomas and Contusions?
Hematomas of the skin and soft tissues are often treated with the RICE protocol:
Some health care professionals may advocate heat as another treatment alternative. The pain of a hematoma is usually due to the inflammation surrounding the blood and may be treated with over-the-counter pain medications. The choice of medication depends upon the underlying health of the patient. For those patients who are taking anticoagulation medications, ibuprofen is relatively contraindicated (not recommended) because of the risk of gastrointestinal bleeding. Patients with liver disease should not take over-the-counter acetaminophen. When in doubt, it is wise to ask the health care professional or pharmacist for a recommendation.
Treatment for hematomas involving other organs in the body depends upon what organ system is involved. In these cases, treatment will be tailored to the specific situation.
There are a couple of things that you can do to prevent or minimize bruising after an injury. First, try a cold compress. Put ice in a plastic bag, wrap the bag in a towel (applying the ice directly to the skin can cause frostbite), and place it on the injured area. Commercial ice packs are also available, but a bag of frozen peas makes an excellent substitute. It molds to the shape of the injured area and can then be re-frozen and used again (but don't eat them!). The cold reduces the blood flow to the area and therefore limits bleeding into the skin and reduces the size of the bruise. The cold also decreases the inflammation in the area of the injury and limits swelling in this way as well. If possible, elevate the area above the level of the heart. The lower an extremity is below the heart, the more blood will flow to the area and increase the bleeding and swelling.
Avoid taking the medications listed above that can contribute to bruising. If you have any questions about whether or not your medication can contribute to bruising, ask your doctor or pharmacist. Do not stop any prescription medications without first contacting your doctor.
Finally, pressure applied to the area (by hand, not with tourniquets) can reduce bleeding.
People who take medicines that reduce clotting ("blood thinners") or have clotting abnormalities should seek the advice of a physician immediately, as should the elderly or those who have experienced significantly severe trauma.