Opening a hematoma: diagnosis, causes and treatment

How do hematomas occur?

Mechanical damage to blood vessels leads to the accumulation of blood that permeates the surrounding tissues. Hematomas can be superficial or deep. According to the location, subcutaneous, submucosal, intramuscular, subfascial formations, and brain hematomas are distinguished. The main factors for their appearance: sudden bruises or pinching of various parts of the body, displacement of bones and ligaments during fractures and dislocations, puncture and penetrating wounds. Most often, hematomas occur as a result of domestic, sports and industrial injuries, after surgical and other invasive medical interventions.

Predisposing factors for the appearance of hematomas:

• decreased blood clotting;
• lack of ascorbic acid and other vitamins in the body;
• increased capillary fragility;
• systemic diseases.

When the vascular walls are damaged, blood flows out of them into the surrounding space, pushing apart and soaking the tissue. Hematomas located close to the surface cause swelling of the integument, numbness in the lesion, sharp or dull pain. Within a few minutes, the swelling spreads, and the skin or mucous membrane over the accumulation of blood becomes blue-purple.

• Pulsating hematomas appear when large vessels are damaged. The blood in them does not form blood clots, flowing from the walls into the cavities and back. When you touch the damaged areas, a fluctuation is felt: an oscillation of the moving liquid.
• Diffuse formations appear when large areas of soft tissue are soaked in blood. In contrast, limited hematomas remain within the cavities.
• Enclosed hematomas resemble tumors. They develop over a long period of time when the cavities are surrounded by a dense membrane of connective tissue.

When do you need to consult a doctor?

For small and superficial hematomas, you can apply cold and apply ointment to the area yourself at home. But when a hematoma occupies a large area on the body, and the size of the swelling around the site of impact increases, the help of specialists is needed. You should also go to the hospital if the hematoma is located on the abdomen and there is a real threat of hemorrhage of internal organs.

Hematomas on the head and near the eyeball are also dangerous. Opening the hematoma may be necessary if it does not go away within a couple of weeks. The doctor will conduct the necessary diagnostics: CT, MRI or ultrasound of organs, radiography and echoencephalography of the head. Based on the research results, the issue of the need for surgical intervention is decided.

Symptoms of hematomas

Subcutaneous hematomas are initially clearly limited in area and have a rich dark color. When the lesion is touched, it causes severe or moderate pain. They require virtually no treatment. Within a few days or weeks, small and large bruises will resolve on their own. Red blood cells in blood clots disintegrate under the action of enzymes:

• bright purple formations become lighter;
• then acquire a greenish or yellowish-blue tint;
• gradually fade and disappear.

Pain and swelling also decrease and disappear.

With deep hematomas, the skin may not change color, since blood clots are not visible through it. The main signs of such formations are: severe pain, limited mobility of the injured part of the body, a feeling of fullness, numbness. The blood in them coagulates within several hours, forming dense accumulations. Less likely to lyse - remains liquid, as platelets are destroyed and lose their ability to clot. Pain during body movements and palpation of injured areas persists for a long time or gradually increases.

In complicated cases, the hematoma cavities become infected and suppuration develops. The formation of an abscess, phlegmon or sepsis becomes possible. Sometimes the clots become scarred and form foci of fibrosis. Feverish symptoms may also appear: fever, chills, muscle aches.

Often deep intramuscular injuries require opening and drainage. The blood in such hematomas can be gel-like, liquid or almost solid, separated from the surrounding tissue.

With brain hematomas, the symptoms are nonspecific:

• dizziness;
• headache;
• noise in ears;
• decreased sensitivity in various parts of the body.

In some cases, decreased vision, photophobia, impaired coordination of movements, increased anxiety, sleep problems and other neurological manifestations are possible. The clinical picture depends on the location of the damage.

Carrying out a puncture

If the hematoma has blood in a liquid state, then the patient’s condition can be alleviated by pumping it out of the tissues. This is done with a needle with a large clearance. Before the procedure, the condition of the hematoma, its location and size are palpated. Then the puncture site is wiped with an antiseptic solution and the pain is numbed.

When inserting a needle into the cavity, you need to lightly press down the tissue surrounding the hematoma. This will make it easier for the contents to come out. After puncture of the soft tissue hematoma, antibiotics are injected into the cavity, if necessary. Over time, the vessels thrombose. The best resorption of the hematoma occurs during thermal procedures. You can lubricate the affected area with ointment.

In case of extensive hemorrhages, several punctures may be necessary, after which antibiotics are continued to be injected into the cavity; after the procedure, a sterile bandage with an antiseptic is applied.

Diagnosis and treatment of hematomas

Everyday superficial bruises do not require special examination or surgical intervention. The diagnosis is made by examining the damaged part of the body. To reduce pain and swelling, it is recommended to apply heating pads with ice or any suitable cold objects to the injuries. To speed up the resorption of small subcutaneous hematomas, they can be treated with local preparations with badyaga and anti-inflammatory components.

Large cavities with a lot of blood and deep formations require opening and subsequent drainage. Before surgery, hematoma sites are examined using ultrasound; in case of damage to hard tissues, radiography is used. The operation is performed in the traumatology department, usually on an outpatient basis, pumping blood from the cavity and suturing the wound under local anesthesia. Then the lesion is tightly bandaged.

In complicated cases and when cerebral hematomas are removed, patients are hospitalized and operated on under general anesthesia.

The prognosis for hematomas is favorable. Even with infected lesions, the chances of completely removing clots and blocking infection of surrounding tissues are high. The healing time depends on the degree and location of the formations. Functionality after surgery is restored within a few days or weeks.

First aid

The first thing to do when a superficial hematoma forms is to apply cold and apply pressure or a pressure bandage. If the patient experiences severe pain, the doctor may prescribe painkillers.

With mild hematomas, a blue spot on the surface of the skin appears after 24 hours. For moderate hemorrhages - after 5-6 hours. In case of severe consequences of injury, a hematoma appears on the surface of the skin a couple of hours after the blow. Here, the help of a professional traumatologist is urgently needed. For hematomas that are large, deep, or have complications, surgical intervention is necessary.

Causes

Hemorrhage usually occurs after injury. This could be a bruise of the skin, internal organs, a concussion or bruise of the brain, an injection with thin (sharp) objects. Sometimes blood leaves the vessels and pours into the skin and internal organs as a result of infections, autoimmune diseases, and poisoning. The occurrence of hemorrhages and bruises is promoted by increased fragility of blood vessels, fasting, lack of vitamins in food, high blood pressure, and congenital bleeding disorders.

At CELT you can get a consultation with a traumatologist-orthopedic specialist.

• Initial consultation – 3,000
• Repeated consultation – 2,000

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Hematoma on the leg

There are several joints on the leg, and in case of extensive leg bruises, you need to check for hematomas located near the knee joint or foot. First, the swelling is removed by applying cold, then the doctor examines the leg to identify internal cavities.

There are cases when, after puncture, the cavity is filled with blood again, since the vessel is not docked or thrombosed. Then the hematoma on the leg is opened surgically. Blood is removed from the cavity, the blood vessel is ligated and sutured.

In order to prevent hemarthrosis, if necessary, the doctor performs a puncture from the joint cavities. If there is an accumulation of blood there, it is removed, and the pain is significantly reduced. It also helps prevent the formation of intra-articular adhesions.

Treatment

Treatment of this pathology in most cases is carried out on an outpatient basis. For “fresh” injuries, the affected area is placed on a hill, ice is applied and a pressure bandage is applied.

To speed up recovery, physiotherapeutic procedures and warming up are prescribed. Small superficially localized formations are opened in a hospital setting. For large and deeply localized hematomas, opening and drainage in a trauma department is indicated. When treating infected lesions after opening, it is recommended to apply a tight bandage and antibiotic therapy.

Subungual hematoma

Injury to fingers or toes is not considered critical for a person’s life, but such hematomas bring quite a lot of concern. As a result of such injuries, the nail plates are often damaged. To reduce the pressure of a blood clot on the nail, you need to open the hematoma by pinpoint burning a hole in the nail, after treating the area with an antiseptic.

The nail does not contain nerve endings, so the procedure is not very painful. After it, you need to apply a damp bandage soaked in an antiseptic, such as Chlorhexidine, or a bandage, on which a little antibiotic ointment is applied.

Orthopedics and traumatology services at CELT

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Classification of hematomas

In modern medicine, when classifying hematomas, the following are taken into account:

• Relation to the vessel - pulsating and non-pulsating hematomas.
• Localization - in the cranial cavity, internal organs, under the skin or mucous membrane.
• The state of the blood in the affected area is suppurated, clotted, fresh, infected.
• Symptoms – limited, encysted, diffuse.

There are hematomas that do not fall into this classification. For example, intracerebral, intracranial, intraventricular. They are of the epidural or subdural type and cause serious complications.

Intracranial hematomas

Intracranial hematomas are divided into the following types:

• Epidural.
• Subdural.
• Intracerebral.
• Intraventricular.

Epidurals appear in 1-3% of cases and are due to injury to the middle meningeal artery. Pathology is often observed with skull fractures or depressed fractures. A hematoma develops in 2-3 hours or within 24 hours. Lack of treatment leads to coma. The first symptoms are confusion and weakness. Children rarely lose consciousness after a severe blow. Significant swelling of the brain does not lead to the detection of a light gap (which is rare in adults).

Subdurals appear in 1-7% of cases and pose a threat to human life, since death occurs in 60% of cases. There is an acute, subacute and chronic form of the pathology. Bleeding occurs due to a rupture of a vein or artery in the damaged area. People report nausea and severe headaches. Symptoms characteristic of compression of the brain stem are often observed. Lack of treatment and worsening symptoms lead to coma.

Intracerebral are observed extremely rarely with severe traumatic brain injuries. The light gap is not visible, the development of pathology occurs quickly. Hemiplegia or hemiparesis often occurs, as well as extrapyramidal symptoms.

Intraventricular diseases are rarely diagnosed due to the serious condition of patients. There are acute disturbances of consciousness, an increase in body temperature, a decrease in heart rate, and an increase in blood pressure. To establish a diagnosis, a survey of close people is carried out, since the patient is unconscious. To establish the location of the hematoma, MRI is used. In the most severe cases, lombal puncture is used.

Predisposing factors

The formation of hematomas occurs after injuries, including pinching, blows, squeezing, and bruises. Subarachnoid hemorrhage does not fall into this category, since it does not appear due to trauma, but due to damage to an unchanged vessel. Often small hematomas appear due to eating large quantities of food or drinking alcoholic beverages. This is due to stretching of the gastrointestinal tract and the appearance of cracks.

The development of pathology is influenced by vascular weakness and problems with blood clotting. Often due to a weakened immune system due to infections or age-related changes, the likelihood of pus accumulating in the affected area increases.

Symptoms

A bruise on the skin is always clearly visible. At first it has a purplish-blue color, and then begins to “bloom”, acquiring yellow and green colors. If a sufficiently large amount of blood accumulates under the skin, a protruding lump forms. At first it is very painful to feel, but later the pain goes away.

The outpouring of blood into the internal organs and into the substance of the brain is preceded by trauma. The main symptom is pain. In this case, the hematoma is not visible externally. If bleeding continues, the victim becomes pale, weak, and dizzy. With chronic internal bleeding, anemia comes to the fore. Bleeding in the brain is especially dangerous. Compression of brain structures may occur, sometimes leading to death.

Diagnostics

A hematoma is diagnosed by visual examination. If the hemorrhage is located deep under the skin, in internal organs, or in a joint, it is often very difficult to assess its size and possible consequences.

Patients are prescribed an examination, which may include:

• Ultrasound of internal organs, joints;
• computed tomography and magnetic resonance imaging;
• puncture (puncture with a needle): for example, a puncture of the knee joint is often done if there is a suspicion that blood has accumulated in it after an injury.