- Bruises and hematomas may appear similar, but hematomas can be more serious and take longer to heal.
- Hematomas involve severe bruising and cann swell and grow as blood leaks into tissue under your skin.
- You can treat both bruises and hematomas at home with the RICE method and OTC acetaminophen.
It’s not hard to confuse a bruise and hematoma, given their similar tenderness and discolored appearance. But hematomas and bruises aren’t exactly the same.
“Technically, a hematoma can be thought of as a bruise. However, hematomas are often much more serious than bruises,” says Jenna Liphart Rhoads, registered nurse and nursing educator at NurseTogether.
A bruise is a collection of blood under your skin that forms when an injury causes tiny blood vessels, known as capillaries, to break. Blood leaks from these vessels into your body’s tissues. Sometimes, enough blood leaks out to form a hematoma, a raised lump on the affected body part.
Here’s how to tell the difference between a bruise and hematoma, when to seek treatment, and why it matters.
Signs and symptoms
You’ve likely experienced a bruise at some point from an accident, fall, or sports injury, so you might find them pretty easy to recognize when they show up.
On the other hand, you might have less familiarity with the signs of a hematoma, even if you’ve had one in the past.
“The main difference between a hematoma and a bruise is that a hematoma develops deep within an extremity and can continue to get larger since there’s active bleeding,” says Dr. Mohamad Moussa, medical doctor and program director at the University of Toledo Emergency Medicine Residency Program.
Here’s how to recognize each, based on their symptoms.
Bruises may initially appear red or purple on lighter skin and purple, dark brown, or black on darker skin.
A bruise will fade in color as it heals, often turning light brown, green, or yellow. It will generally go away within two weeks without treatment. The skin above and around your injury may feel tender until it heals completely.
“Hematomas are often much more painful than a bruise and take much longer to fully heal,” Rhoads says.
A hematoma involves the same discoloration as a bruise, but that’s where the visual similarities end.
Hematomas present with larger and more severe bruising. Unlike a typical bruise, a hematoma will appear swollen or raised because of the leakage of blood into your body’s tissues.
The pain and swelling from a hematoma typically fade within one to four weeks as your body absorbs the leaked blood. But this process may last up to several months, depending on the hematoma’s size.
Subdural and epidural hematomas
Subdural and epidural hematomas are serious neurological conditions that typically result from head injuries. This happens when blood builds up between your skull and the dura, a protective covering that surrounds your brain.
Epidural hematomas happen when blood builds up between your skull and the dura, a layer of connective tissue that surrounds and protects your brain. These typically come on quickly, shortly after a major head injury. Young people, men, and people who’ve had a skull fracture are most at risk.
Subdural hematomas, on the other hand, develop between the dura and the next layer of tissue, the arachnoid layer. Babies, athletes, people over age 65, and people who regularly drink a lot of alcohol have a higher risk of subdural hematoma.
Symptoms can include:
- Confusion, aggression, or sudden shifts in mood
- An increasingly painful headache
- Feeling sick or vomiting
- Loss of consciousness
- Slurred speech
- Double vision
Untreated subdural and epidural hematomas can cause lasting brain damage or death. You should seek emergency medical help immediately if you notice these symptoms after a recent head injury, especially one that involved a loss of consciousness.
What causes them?
“Hematomas usually result from high force traumas, such as falls or motor vehicle collisions. Bruises can result from low force falls, sporting activities, and even when someone gets blood drawn from their arm,” Moussa says, adding that both are more likely in people who take blood-thinning medications.
Everyone experiences bruising at some point, but older adults tend to bruise more easily since skin naturally thins with age.
Some medical issues can also make you more vulnerable to bruising.
You may be more likely to bruise if you have:
- Liver disease
- Vitamin C, vitamin D, or vitamin K deficiency
- Family members who bruise easily
- A bleeding disorder like hemophilia or von Willebrand disease
- Low blood platelet count
Frequent use of nonsteroidal anti-inflammatory drugs, such as ibuprofen, aspirin, and naproxen can also make you bruise more easily.
Unexplained or frequent bruising can also happen if you take antibiotics and antidepressants that list difficulty with blood clotting as a side effect. As a result, bleeding from damage to blood vessels near your skin’s surface could take longer to stop. This can cause bruising by allowing blood to leak under your skin.
Bruising easily might indicate a serious underlying condition like a blood clotting issue or blood disease. If you bruise easily, your clinician can give you a physical exam and order blood testing to determine the correct diagnosis and treatment.
Hematomas are caused by an injury to any blood vessel, including your arteries, veins, or small capillaries. This can include traumas and medical conditions, such as:
- Head injuries
- Car accidents
- Bone fractures
- Blood cancers
- Liver disease
Acute subdural and epidural hematomas are caused by serious head injuries, with symptoms beginning shortly after the event. Rarely, a subacute or chronic subdural hematoma may go undetected for a few days or weeks after a minor head injury. Either can have serious health consequences.
Why it’s important to recognize the difference
“A hematoma is a greater concern because it can continue to expand and constrict surrounding body structures, such as blood vessels and nerves. These can be insidious because they develop deep below the skin and might not be noticeable immediately,” Moussa says.
Moussa notes that hematomas can also cause your hemoglobin count to go down, which would require a blood transfusion.
A subdural or epidural hematoma can also cause epileptic seizures. One 2017 study found that 28% of participants who experienced a subdural hematoma also developed traumatic epileptic seizures.
“Most hematomas are self-limited, but serious hematomas can lead to shock and require aggressive resuscitative measures. These can result in deadly blood loss from internal bleeding,” Rhoads says.
While hematomas generally pose more serious health risks, bruises can also pose a cause for concern, especially if you get them often and don’t know why they happen.
“Continuous bruising or bruises that do not heal can be a sign of leukemia, which can be fatal if left untreated,” Rhoads says.
You could also bruise easily for other reasons, including vitamin deficiency and steroid medications.
“Sometimes bruises can be associated with subsequent scarring and deformities if the skin is lacerated or if bones are broken near the bruise,” Moussa says.
How to treat them
Most hematomas and bruises don’t require medical treatment and can be cared for at home.
You can treat hematomas just under your skin with the same home care you would use for a standard bruise – the RICE method.
Using the RICE method on your bruise or hematoma helps constrict blood flow, reduce swelling, and temporarily deaden pain receptors in the affected area. The RICE treatment can reduce time lost to injury by over 40% and lower your risk of scar tissue formation.
Pain relief medicine
Over-the-counter acetaminophen (Tylenol) can help with your pain, but you should avoid aspirin and ibuprofen-based pain relievers like Advil and Motrin.
Nonsteroidal anti-inflammatory drugs can increase your risk of bleeding by slowing down blood clotting.
Surgery is often used to treat subdural and epidural hematomas, with craniotomy being the most common treatment.
What it involves: Once you’re asleep under anesthetic, a neurosurgeon will create a temporary flap in your skull and gently wash away your hematoma via suction and irrigation. They’ll close the flap with metal plates or screws.
Burr hole surgery is the most common option for chronic subdural hematomas that develop a few days after a head injury.
What it involves: Once you’re asleep under anesthetic, a neurosurgeon will drill one or more small holes into your skull and use a rubber tube to drain the hematoma. Your clinician will either close the dura and scalp immediately or create a temporary drain to help remove excess fluid and close any holes shortly after.
You’ll typically be able to leave the hospital within a few days after either surgery.
Most bruises and hematomas go away on their own. If you frequently bruise for no apparent reason, notice any symptoms of a subdural hematoma, or have a hematoma that won’t heal, it’s time to make an appointment with a clinician.
“You should seek immediate medical attention if you notice a hematoma increasing in size or if you’re experiencing symptoms of extreme blood loss, like feeling dizzy or lightheaded with a rapid pulse or fainting,” Rhoads says.
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