Hematomas present as hard, solid and painful lumps or swellings under the skin. The overlying skin is often bruised and discoloured with ecchymosis as a common presentation. Intracranial hematomas also have symptoms of severe headache, nausea and vomiting, double vision, seizures and unconsciousness. The clinical presentation of intramural hematoma (IMH) and aortic double-lumen dissection (AD) is often similar  so a difference needs to be made with the help of imaging studies. Rectus sheath hematomas present with abdominal pain along with a palpable lump.
Entire Body System
The chest drainage tube was removed on postoperative day 12 because of persistent air leakage, but fever appeared the same day. Computed tomography revealed a cavity with mixed air and fluid, so antibiotics were started on suspicion of abscess. [ncbi.nlm.nih.gov]
Hemorrhagic fever, which literally stands for bleeding fever, produces the tell tale bruising all over the body. Other illnesses such as cancer that leave a loved on confined to a bed can be causes for such instances of blood related problems. [healthguidance.org]
Large ones may present with lower abdominal pain, dysuria, anemia and fever (if infected). It is an uncommon complication of cesarean section, due to bleeding and uterine dehiscence, usually at transverse lower uterine incision. [radiopaedia.org]
If infection should develop in the wound, the signs and symptoms might be increasingly severe pain, a fever of 101 degrees or more, swelling with surrounding redness, and pus. [healthcentral.com]
You have a fever. You have trouble moving the body part that has the hematoma. Contact your healthcare provider if: You have questions or concerns about your condition or care. [drugs.com]
- Developmental Disorder
Epidural hematoma causes cerebral palsy and other developmental disorders in infants, so it’s especially important that they are quickly treated if they occur during or after childbirth. [cerebralpalsysymptoms.com]
- Abdominal Mass
Computed tomography with intravenously administered contrast agent showed a solid mass of 5 × 5 × 8 centimeter in the left middle abdominal quadrant. [ncbi.nlm.nih.gov]
WHAT CAUSES AN ABDOMINAL MASS? Abdominal masses can be the result of a number of factors, including an injury, cyst, tumor, cancer, or disease. [slideshare.net]
The Fothergill sign (mass in the abdominal wall that does not cross the midline and does not change with flexion of the rectus muscles is suggestive of a rectus sheath hematoma) is useful to determine if the abdominal mass is within the abdominal wall [statpearls.com]
Below the arcuate line, the aponeuroses remain intact anteriorly, but only the weak transversalis fascia and peritoneum separate the muscle mass from the abdominal viscera posteriorly. [reference.medscape.com]
[…] adminadministratitrationlow-dosecurrence of a massive hematomathe rectus sheath is reported in a woman with chronic obstructive pulmonary disease and acute respiratory failure who was receiving low doses of heparin for the prevention of deep venous thrombosis [jamanetwork.com]
Deep vein thrombosis of the lower leg was identified and edoxaban, a so-called novel oral anticoagulant, was started on postoperative day 7. [ncbi.nlm.nih.gov]
A nurse on the island thought it could be a thrombosis. Since then a smaller "bubble" has appeared beside the larger one. [daneurope.org]
Two patients had thrombosis of the basilar artery in the remainder descendent, ascendent, transtentorial herniations and extracranial hemations of the cerebral tissue were involved. [medvik.cz]
Enforced bed rest in elderly patients may lead to pneumonia, deep venous thrombosis, and aspiration. [americannursetoday.com]
Physical examination revealed large semirecent hematoma with a large soft fluctuant area with hypermobility of the skin and cutaneous hyperesthesia, spreading from her behind to the anterior face of her thigs. [ncbi.nlm.nih.gov]
In this case report, we will discuss mimicking angioedema and caused by a bite due to dystonia and separation of the tongue from the base of the mouth developing concurrently with lingual hematoma. [ncbi.nlm.nih.gov]
Work up includes a thorough physical and neurological examination and patient history, followed by some laboratory tests and imaging studies
- Complete blood count
- Prothrombin time and APTT
- Liver function tests
- Serum BUN and electrolytes
- GCS measurement
- Serum alcohol levels
CT scans and MRI are the primary investigative and diagnostic tests for hematomas. Pre-contrast CT scans of an organized hematoma show hyperdense masses with or without calcification . Doppler ultrasounds may also be conducted if needed.
On the basis of a thorough clinical examination and imaging studies the exact location and the extent of the hematoma can be found out. Tests can also help in assessing the risk of rupture of the hematoma and appropriate treatment can be accordingly planned.
Treatment of a hematoma depends on the severity and extent of the hematoma. According to panel consensus statements, if progressive hemorrhage as shown by 2 successive CT or MRI scans along with haemodynamic instability, persistent pain and signs of impending rupture are present, immediate surgical treatment is recommended. If such conditions are absent, medical treatment is recommended .
According to the findings of a recent study chances of a good recovery are possible if an aggressive surgical approach is taken in particular cases like those of patients with extradural hematomas . Treatment with medication includes the use of osmotic diuretics, anticonvulsants, analgesics and corticosteroids. In cases of intracranial hematomas, antacids may also be given to reduce the chances of gastric ulcers.
If not treated, intracranial hematomas pose a negative prognosis with very high rates of mortality. The prognosis depends on the size, shape and thickness of the hematoma and how much it is suppressing the underlying and neighbouring structures. Hematomas occurring in the limbs as a result of trauma or in the abdomen usually have a good prognosis. Some hematomas don’t even require treatment and spontaneously resolve.
Causes behind intracranial hematomas include blunt head trauma, clotting disorders, intracranial hypotension like after spinal epidural anaesthesia  and lumbar puncture. Some of them are even idiopathic. Underlying arteriovenous (AV) malformations were also identified in one study .
Other hematomas can occur due to different causes. Some anticoagulant drugs like heparin or warfarin can also disrupt normal coagulation and cause hematomas. A study reported a case of sublingual hematoma secondary to warfarin therapy . Trauma, AV malformations and clotting disorders are also various other kinds of hematoma formation.
Subdural hematomas are more common in men, with a ratio of 3:1. Epidural hematomas are also more common in men, with a ratio of 4:1.
Hematomas are localized accumulations of blood outside the blood vessels. Epidural hematomas most commonly involve the middle meningeal artery. They are due to blunt trauma that causes the dura mater to separate from the periosteum and the blood vessels in between to stretch and rupture. This leads to rapid leakage and flooding of blood between the meningeal layers. Subdural hematomas are also typically due to trauma. Some chronic subdural hematomas may enlarge from an osmotic gradient, drawing more fluid into the subdural space. The mechanism of calcification can also be the pathogenesis behind hematoma formation . According to a study performed by Kawakami in 1989, it was found that the coagulation and fibrinolysis systems were both excessively activated due to unknown causes in cases of chronic subdural hematoma .
Rectus sheath hematoma (RSH) may develop due to rupture of epigastric arteries in the abdomen or the rectus muscle itself due to severe trauma . Other less common types of hematoma include subungal hematoma which occurs under or around the nailbed, perianal hematoma, subgaleal hematoma which occurs between the periosteum and the galeal aponeurosis and subdermal hematoma which occurs under the skin and typically in muscles.
Hematomas are localized collection of extravasated blood that leaks out of ruptured blood vessels and accumulates in the surrounding area. The hematoma may occur inside muscles, in internal organs, between two membranes, in joint cavities and under the skin. According to the area or site of the hematoma, it can be named and divided. By far, intracranial hematomas pose the greatest risk of rupture and damage, even death. Hematomas occurring under the skin of limbs and joints are less dangerous, but no less painful.
A hematoma is a collection of blood outside the blood vessels which appears as a hard lump or swelling.
Signs and symptoms
Diagnosis is made be carefully assessing the physical findings and the results of imaging studies and laboratory tests.
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