Is It a Bruise or a Hematoma?

Bruises and hematomas occur when blood leaks outside of an injured blood vessel after a trauma. There are many differences between them, including their appearance, symptoms, and healing time, as well as the types of blood vessels involved.

This article explains how to distinguish bruises from hematomas. It also covers why they occur and treatment options.

What Is a Bruise?

A bruise is a mark on the skin caused by small amounts of blood leaking from crushed small blood vessels, like capillaries. Bruises may also be referred to as ecchymosis or a contusion,

Those that occur under the surface of your skin are usually quite visible. The initial black and blue skin discoloration will change to a yellow, green, or light brown color within five to 10 days.

Bruises are flat, although mild swelling may be present. They can be tender to the touch.

Bruises can also form in deeper tissues, including muscles and bones. Though you won't see them, you will feel pain and soreness in the area of the injury.

Bruises usually heal on their own within a week or two. They rarely cause serious complications, but can if there are additional injuries. For example, a black eye from a face injury may cause vision problems.

What Is a Hematoma?

Hematomas are larger bleeds that often involve larger blood vessels. With a hematoma, the leaking blood will pool and clot, or form clumps of blood. This can cause a firm and tender mass.

Hematomas can develop deep within the body, like in a muscle or in or around an internal organ. They can also form beneath the skin, on the scalp, nose, ears, or under a nail.

When it is closer to the surface of the skin, the hematoma may appear as a painful red, black, or blue lump. As it breaks down, the skin will eventually change to a yellow or brown color.

Unlike bruises, hematomas can cause serious harm. If they get large enough, they may cause blood pressure to drop. They can even lead to shock, a life threatening condition that happens when organs in the body don't get enough blood or oxygen . Very large hematomas can cause organs to shift and affect how they function.

The most dangerous and life-threatening hematomas are in the brain and skull. With these, the blood can become trapped within the skull and put pressure on the brain.

This can cause:

• Brain damage
• A coma, or a state of long term unconsciousness
• Paralysis, or weakness or total loss of movement in the muscles in part of your body
• Seizure, or a sudden burst of uncontrolled activity in the brain

Healing time ranges from weeks to months, depending on the size and location of the hematoma.

What Are Causes and Risk Factors?

Bruises and hematomas both occur when a force—usually a blunt force—directly impacts the body, causing blood vessels to break open. Examples include falls, car accidents, and sports injuries.

Medical procedures and broken bones can also cause bruises and hematomas.

There are certain factors that may increase a person's risk of bruises or hematomas:

• Older age
• Bleeding disorders, like hemophilia, a condition that causes difficulty with blood clotting
• Thrombocytopenia, or a low count of a type of blood cell that helps stop bleeding
• Alcohol use disorder
• Liver disease, or a group of conditions that lead to liver damage
• Vitamin C or K deficiency
• Severe viral infection
• Blood cancer

Certain drugs can also increase the risk of bruises or hematomas:

• Nonsteroidal anti-inflammatory drugs (NSAIDs) like aspirin
• Blood thinners, like heparin and Coumadin (warfarin), which may be used to treat blood clots
  
• Corticosteroids like prednisone, which may be used to treat inflammatory conditions
• Certain antibiotics, which are used to treat bacterial infections
• Certain supplements like Ginkgo biloba, omega-3 fatty acids, and garlic

How Are These Diagnosed?

Most of the time, healthcare providers can diagnose a bruise or hematoma on the skin just by looking at it during a physical exam. For suspected bone bruises, an imaging test, like an X-ray, may be ordered to check for broken bones.

In the case of an internal hematoma, including one in the skull or brain, imaging tests like a computed tomography (CT) scan or magnetic resonance imaging (MRI) may be required.

How Are These Treated?

You may be able to treat mild bruises or hematomas at home. Larger or internal hematomas may require medical care.

Bruises and Superficial Hematomas

Bruises may heal on their own, but may benefit from treatments like the RICE method (rest, ice, compression, and elevation).

This involves:

• Rest and elevate the area where the bruise/hematoma is to minimize swelling and ease discomfort.
• For the first day or two after the injury/trauma, apply a bag of frozen peas or an ice pack wrapped in a towel to the affected area for 10 to 15 minutes several times a day.
• Gently compress the injured area with an elastic bandage if swelling is present.

Hematomas on the skin may benefit from a similar approach, although a splint may be advised to keep an injured limb from moving and prevent the larger vessel from breaking open again.

Larger or Deeper Hematomas

Hematomas that are pressing on a nerve or blood vessel, or are causing tissue damage may require surgical drainage or removal. The drainage of any hematoma must be done before the blood clots and forms a solid mass.

In terms of skull hematomas:

• Bed rest and observation may be all that is needed for small skull hematomas.
• For large skull hematomas, a procedure known as burr hole surgery may be used to drill a hole in the skull in order to drain the trapped blood.
• Severe cases may require a craniotomy, during which a piece of skull bone is temporarily removed to extract the trapped blood.

If surgery is done, a drain may be left in place for a couple of days while the individual is closely monitored in the hospital.

Summary

Bruises result from an injury to smaller blood vessels, while hematomas result from injury to larger blood vessels.

While bruises rarely cause serious complications, hematomas can—particularly those in the skull or brain.

Most bruises and superficial hematomas can be diagnosed with a physical exam and treated with the RICE method. Larger or deeper hematomas may require imaging studies and surgery.

A Word From Verywell

Developing a small hematoma or a bruise may be uncomfortable, but it will likely heal on its own. That being said, be sure to seek medical attention if your bruise or hematoma is very painful, is associated with serious trauma, or if you have signs of infection.

You may also want to notify your doctor if you tend to bruise easily or often as this could be linked to an underlying medical condition or medication.