A hematoma is an accumulation of blood in the tissues of the human body, and its occurrence is caused by damage due to falls and blows. In some cases, the appearance of a hematoma is not associated with physical effects, but is explained by the presence of a specific disease in a person.
In most situations (this applies to small hematomas), serious consequences do not occur, and the inflammation itself disappears after some time. However, there are often cases that require medical consultation and qualified treatment. Ignoring a bruise can lead to the formation of a cyst or tissue necrosis.
Why it is not recommended to treat a hematoma on the leg at home
If there is large accumulation of blood under the skin, it must be removed. There are enough videos and articles on the Internet describing this procedure at home, but you absolutely cannot follow such advice. Firstly, a person risks damaging his leg even more and disrupting its normal functioning, even to the point of disability. Secondly, and more likely, you can introduce an infection into the body and provoke even greater inflammation. Thirdly, only an experienced doctor using special equipment will do this carefully, but independent attempts can permanently disfigure the skin and leave unaesthetic scars on it.
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.
Treatment of hematoma on the leg
Typically, a hematoma on the leg after a bruise is treated by two methods: conservative and surgical. The first category includes: cold and warm compresses, pressure bandages, taking analgesics, applying ointment, physiotherapeutic manipulations.
The second group involves performing a puncture - surgical removal of accumulated blood from the site of a bruise with the application of a suture and an aseptic bandage.
Treatment of a serious hematoma on the leg must be carried out under the guidance of a doctor; this will speed up the healing process and prevent unpleasant consequences.
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.
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.
Orthopedics and traumatology services at CELT
The administration of CELT JSC regularly updates the price list posted on the clinic’s website. However, in order to avoid possible misunderstandings, we ask you to clarify the cost of services by phone: +7
| Service name | Price in rubles |
| Appointment with a surgical doctor (primary, for complex programs) | 3 000 |
| X-ray of the chest organs (survey) | 2 500 |
| Ultrasound of soft tissues, lymph nodes (one anatomical zone) | 2 300 |
All services
Make an appointment through the application or by calling +7 +7 We work every day:
- Monday—Friday: 8.00—20.00
- Saturday: 8.00–18.00
- Sunday is a day off
The nearest metro and MCC stations to the clinic:
- Highway of Enthusiasts or Perovo
- Partisan
- Enthusiast Highway
Driving directions
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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Our doctors
Poltavsky Dmitry Ilyich
Traumatologist-orthopedist
Experience 28 years
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Zubikov Vladimir Sergeevich
Traumatologist-orthopedist, Doctor of Medical Sciences, doctor of the highest category, professor
44 years of experience
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Marina Vitaly Semenovich
Traumatologist-orthopedist, head of the minimally invasive traumatology and orthopedics service
Experience 36 years
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Samilenko Igor Grigorievich
Traumatologist - orthopedist, doctor of the highest category
24 years of experience
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Publications in the media
Acute traumatic subdural hematoma is an accumulation of blood in the space between the inner layer of the dura mater and the arachnoid membrane of the brain. Patients with acute traumatic subdural hematoma typically exhibit significantly greater primary brain damage than patients with epidural hematoma, and therefore treatment outcomes for this group of patients are significantly poorer.
Etiology and pathogenesis • Accumulation of blood around the source of bleeding in the area of the brain crush (usually the pole of the frontal and temporal lobes). In this case, there is significant primary damage to the entire brain, there is no “bright gap”, general cerebral symptoms dominate in the form of a gross disturbance of consciousness • Rupture of the “bridge” veins as a result of a sudden movement of the head during acceleration/deceleration. Primary brain damage is smaller and there may be a “bright period” followed by rapid deterioration. It should be remembered that in patients receiving anticoagulants, the risk of developing a subdural hematoma is significantly higher (7 times in men and 26 times in women compared with the general population). In such patients, even a minor injury can lead to a life-threatening hematoma.
The clinical picture is nonspecific and reflects the severity of primary TBI; sometimes a variant of the course with a “light” interval is observed (see Epidural hematoma).
Diagnostics. CT scan reveals a crescent-shaped space-occupying formation located between the convexital surface of the brain and the inner plate of the bones of the calvarium. Depending on the age of the hematoma, the signal intensity varies greatly
• 1–3 days (acute hematoma): the density on CT is high.
• From 4 days to 2–3 weeks (subacute hematoma): density similar to that of brain tissue.
• From 3 weeks to 3 months (chronic hematoma): low density (approaching the density of cerebrospinal fluid).
• More than 3 months: may take the form of a lens (like an epidural hematoma), the density is higher than that of cerebrospinal fluid, but lower than that of fresh blood.
Treatment. In most cases, acute subdural hematoma requires emergency surgical intervention - craniotomy, removal of the hematoma. The absolute indication for surgery is a hematoma more than 1 cm thick according to CT data. In the postoperative period, intensive therapy is required to support vital functions and control the level of ICP (should be less than 25 mm Hg) - mannitol, ventricular drainage, barbiturates, hyperventilation.
Forecast. The mortality rate is 50–90%, but it should be borne in mind that it is primarily due to the primary traumatic brain injury and not to the hematoma itself. In elderly patients (over 60 years of age) and in patients receiving anticoagulants, mortality approaches 90–100%. Recently, factors influencing the prognosis of acute traumatic subdural hematoma have been intensively studied. Independent factors that reliably influence the prognosis: • Mechanism of injury: the worst prognosis for a motorcycle injury: without a helmet, mortality is 100%, with a helmet - 33% • Age over 65 years significantly worsens the prognosis (mortality 82%, “functional” survival 5%) • Postoperative ICP level: less than 20 mm Hg. — mortality 40%, more than 45 mm Hg. — almost 100% • Neurological status at the time of admission to a specialized hospital.
Mortality and “functional” survival (i.e., with preservation of at least the ability to self-care) depending on the severity of TBI • 3 points on the Glasgow scale (mortality 90%, “functional” survival 5%) • 4 points on the Glasgow scale (mortality 76%, “functional” survival 10%) • Glasgow score 5 (mortality 62%, “functional” survival 18%) • Glasgow score 6–7 (mortality 51%, “functional” survival 44%)
Chronic subdural hematoma, despite its external similarity with acute subdural hematoma, has a number of significant differences.
Chronic subdural hematoma
Epidemiology. Chronic subdural hematoma usually occurs in older people (average age 63 years). In less than 50% of them, a history of TBI can be identified. In 20–25% of cases, chronic subdural hematoma is bilateral.
Risk factors • Alcoholism • Epilepsy • Shunt surgery for hydrocephalus • Coagulopathy.
Etiology and pathogenesis. It is believed that a chronic subdural hematoma forms from an undetected (most likely minor) acute subdural hematoma. Blood entering the subdural space causes an inflammatory reaction, fibrin falls out and a hematoma capsule is formed. Subsequently, vascularization of the capsule, fibrinolysis and “liquefaction” of the blood clot in the center of the hematoma occur. The course of the hematoma is determined by the ratio of the processes of plasma filtration from the capsule and microhemorrhages into the cavity on the one hand and reabsorption of the contents of the hematoma on the other.
The clinical picture is very variable: from minimal manifestations (prolonged headaches, increasing dementia and behavioral disorders) and symptoms reminiscent of transient ischemic attacks, to the development of seizures, hemiplegia and coma (an extremely unfavorable course). In many cases, it is not possible to make a correct diagnosis until a brain CT scan is performed.
Diagnosis: CT or MRI of the brain. In some cases, MRI is more informative (for example, in patients with so-called “isodensity” bilateral hematomas, when the hematoma is indistinguishable in density from the brain parenchyma, and there is no dislocation of the midline structures.
Treatment. All symptomatic hematomas and asymptomatic hematomas larger than 1 cm are subject to surgical treatment. The purpose of the operation is to remove the liquid component of the hematoma (a minor operation through a burr hole that can be performed under local anesthesia). Removal of the capsule is not indicated in most cases, because significantly increases surgical trauma and may cause additional gross neurological deficits. Before surgery, a study of the hemostasis system is required and any violations identified are corrected. The advisability of prophylactic administration of anticonvulsants is debatable, because this does not affect the risk of developing “late” seizures.
Forecast. An improvement in the neurological status is observed in almost all patients immediately after drainage, and there is a pattern: the higher the pressure in the hematoma, the more pronounced the clinical effect will be. Mortality, according to various authors, ranges from 0 to 8% and is determined primarily by the general condition of the patient, and not by the fact of hematoma drainage itself. On control CT scans performed on the 10th day after surgery, remnants of the hematoma are detected in 78% of cases, after 1.5 months - in 15%. Indications for repeated drainage are an increase in the volume of hematoma remnants and deterioration of the patient’s neurological status.
ICD-10. I61 Intracerebral hemorrhage
