Is It a Bruise or a Hematoma?

Bruises and hematomas tend to present similarly, but they are two different conditions. A hematoma is a more serious and sometimes even life-threatening condition. Bruises usually do not require medical attention, whereas hematomas may require immediate care, especially for the more severe types.

Learning about the causes and symptoms of a bruise and a hematoma will allow you to recognize each condition, tell the difference between the two, and better understand the treatment required.

Bruises, also known as contusions, appear on the skin as a result of trauma to the body. They occur when the small veins, capillaries, and muscle and fiber tissues under the skin break. Bruises are usually the result of a direct hit or repeated hits from blunt objects striking a part of the body.  

Minor bruises will heal very quickly without affecting a person’s day-to-day life. Severe bruises, however, can cause deep tissue damage and lead to complications including infections that require time and antibiotics to heal. While bruises rarely cause damage to internal organs, a blow to the stomach, for instance, could cause bruising to internal organs and require a longer healing time.

Other causes of bruises include bleeding disorders or bleeding from thinning skin due to aging. Some people are at higher risk for bruising.

A hematoma is a collection of blood outside of a blood vessel. Hematomas are caused by injury to the wall of a blood vessel, which pushes blood out to surrounding tissues. Hematomas can affect any type of blood vessel including arteries, capillaries, and veins.  

Traumas are the main causes of a hematoma. This can include car accidents, head injuries, falls, and gunshot wounds. Other causes of hematomas include:

• Certain medications
• Aneurysms
• Viral infections (Chicken Pox, HIV, or Hepatitis C)
• Fractures

Some people are at higher risk for hematomas as well.

The most dangerous types of hematomas are epidural, subdural, and intracerebral, and those that occur inside the skull. Since the skull is a closed off area, anything that causes buildup affects the brain’s ability to work effectively.  

Other common types of hematomas include:

• Scalp. This occurs outside the skull and is usually identified by a bump on the head. The damage is to the skin and muscle, so it will not affect the brain.
• Ear. A hematoma in the ear can affect blood supply and cause tissues of the ear to die.
• Septal. This type of hematoma is generally related to a broken nose. If not treated, they cause nasal problems. 
• Intramuscular. These hematomas are painful due to inflammation, swelling, and irritation. When the blood supply in the muscle is affected, the nerves might be harmed. This type is often seen in the lower legs and lower arms.
• Subungual. These hematomas tend to be related to wounds of the toes and fingers. Bleeding occurs under a toenail or fingernail, causing pressure and blood to build up.
• Subcutaneous. People on blood thinning medications are the most susceptible to subcutaneous hematomas. These occur under the skin and affect the shallow veins. 
• Intra-stomach. These hematomas cause blood buildup in strong organs such as the kidneys and liver. They may also affect the covering of the stomach, called the peritoneum.  

Hematomas of the skin and other soft tissues are treated with rest, ice, and pressure (by using a splint or wrap). Stabilizing the affected area can prevent the blood vessel from reopening, reduce pain, and improve function while the hematoma is healing. Hematoma pain and swelling may be treated with over-the-counter (OTC) pain medications. Aspirin should not be used as it may increase bleeding. If the pain is severe, doctors may prescribe strong pain relievers.

There are many differences between bruises and hematomas, including the blood vessels affected, appearance and symptoms, healing time, and complication risk. 

Both bruises and hematomas result when blood leaks outside of blood vessels after a trauma. Hematomas tend to occur deep inside the body where damage is not visible, while bruises tend to be quite visible. However, bruises are not always visible (for example, a bruised rib). Hematomas can be large and dangerous, and they can even affect the brain when there is no place for pooled blood to go. 

Bruises result from small leaks from smaller blood vessels. They cause black and blue discoloration, firmness of tissue (known as induration), and are usually painful. They are flat and discolored. Bruises heal on their own without treatment within a week or two, after the bleeding has stopped. They rarely worsen or cause dangerous complications. On the other hand, hematomas are larger bleeds and will often involve larger blood vessels. This causes leaking blood to collect into its own space, forming a pool of blood. When superficial, this pool presents as a fluid-filled, painful mass, often red in color. Hematomas can be become quite large and collect enough blood to cause low blood pressure and shock. Very large hematomas can displace organs, cause organ dysfunction, and may require surgery to repair damage. 

In the case of a hematoma in the skull, for instance, brain bleeding is difficult to detect without appropriate testing and required medical treatment. Symptoms of a potential hematoma in the skull may include:

• Increasing headache
• Drowsiness 
• Confusion
• Dizziness 
• Vomiting 
• Slurred speech

Lethargy, seizures, and unconsciousness are the most serious symptoms of a hematoma of the brain or skull. Anyone who has had an injury to the head and/or is experiencing these types of symptoms should always seek immediate medical attention. Whether it is a bruise or a hematoma, head injuries should be closely monitored to reduce complications and allow for immediate and timely medical attention. 

While bruises and hematomas may have similar causes, bruises rarely require medication attention. Because hematomas cause internal bleeding, it is a good idea to seek medical attention any time you experience symptoms of a hematoma or find blood pooling underneath the skin. Anyone who finds they are bruising often and/or more easily should talk to a doctor, as it is possible an underlying medical condition could be to blame.