traumatology

Hematoma or Ecchymosis

SIMILARITIES
  1. Both hematoma and ecchymosis identify extravasation of blood concentrated outside the blood vessels, an expression of trauma capable of breaking the vessel walls, without injuring the skin
  2. Both hematoma and ecchymosis are induced by trauma, bumps or bruises
  3. Both bruises can be favored by alterations in the coagulation capacity of the blood (leukemia, thrombocytopenia, hemophilia) and by anticoagulant therapies
  4. The lesions modulate the color scheme with the passage of time: the hematomas and ecchymoses, at first red, become blue / violet, then green and, finally, yellow
  5. They can be easily confused, especially in complex traumas (ecchymotic mask → hematoma)
  6. Minor bruising and bruising are treated simply by applying ice bags. The most severe forms require surgical evacuation
DIFFERENCES

HEMATOMA

  1. Expression of a severe trauma
  2. The lesion often involves medium and large caliber vessels
  3. The size of the hematoma exceeds 2 cm in diameter
  4. Typical complication of surgical wounds

ecchymosis

  1. Expression of a mild to moderate contusion
  2. The capillaries and small veins are the most affected vessels
  3. The size of the ecchymosis is between 1 and 2 cm
  4. They can also be induced by scurvy, lupus erythematosus and phlebitis

Hematoma or ecchymosis?

It is not uncommon for the terms "hematoma" and "ecchymosis" to be mistaken for synonyms. In fact, the general definition of both contusive forms is almost identical; moreover, both hematomas and ecchymoses are induced by the same causes.

But why, then, can an ecchymosis properly be called "hematoma"?

The answer is rather simple, although not always so immediate: the difference between hematoma and ecchymosis lies essentially in the severity of the trauma.

But let's try to make things a bit clearer, focusing on the elements that unite and differentiate the two bruises.

definitions

  1. The term HEMATOMA defines a blood spill outside the bloodstream: after traumas, bruises or violent bumps, the blood escapes from the blood vessels, concentrates in a tissue or in a cavity of an organ, and gives rise to a hematoma.
  2. ECCHIMOSIS is an extravasation of blood in a tissue, a consequence of a trauma able to break the vessel walls, without injuring the skin.

BUT WHAT IS THE DIFFERENCE?

The definitions given above are effectively equivalent: both hematoma and ecchymosis identify blood collections outside the blood vessels, following a trauma.

This definition is quite general and does not clarify the differences.

To understand what distinguishes a hematoma from an ecchymosis we must go back to the severity of the trauma suffered.

  1. A hematoma is the result of a violent blunt trauma, such as to create abundant accumulations of blood in a tissue or in a cavity of the organism. The proper hematoma originates from the rupture of large blood vessels. By definition, the size of the hematoma exceeds 2 centimeters in diameter.
  2. An ecchymosis is the consequence of a less violent bruise. Synonymous with bruise, ecchymosis is caused by the rupture of small blood vessels. An ecchymosis, to be defined as such, must be between 1 and 2 centimeters in size .
  • Lesions less than one centimeter take on another connotation: we speak of purple when the bruise diameter is between 3 mm and 1 cm, and of petecchia, if the dimensions are less than 3 mm.

Despite this differentiation, it is not uncommon for hematoma and ecchymosis to be confused. In severe trauma, the two clinical conditions coexist and overlap, giving rise to a huge lesion, with poorly defined margins. Thus the so-called "ecchymotic mask" can be defined as a full-fledged hematoma.

WHAT ARE THE ANALOGIES?

Causes

From the etiopathological point of view, the hematoma and ecchymosis can be induced by the same causes.

The most frequent hematomas, as well as for ecchymoses, are the expression of bruises or more or less violent traumas on the skin.

In addition to traumatic contusions, both ecchymoses and hematomas can be determined by several factors:

  • Alteration of blood coagulation capacity (hemophilia, thrombocytopenia)
  • Leukemia
  • Systemic lupus erythematosus, phlebitis and scurvy: infrequent. Hardly these morbid diseases create hematoma; sometimes they can predispose the patient to ecchymoses.
  • Anticoagulant therapy (heparin, dicumarol, coumadin etc.)
  • Trauma from surgical wounds: after surgery, the hematoma (more often) and petechiae (less frequently) constitute a complication.

Cures and treatments

Clearly, the ideal treatment depends on the severity of the trauma suffered. We have seen that the hematomas originate from violent bruises, such as to break even the walls of the medium and large caliber blood vessels; the ecchymosis is instead the result of a less violent trauma. From what has been said, it is understandable that the hematoma requires more "important" care than an ecchymosis.

The location of the trauma must also be assessed: superficial hematomas - as well as ecchymoses - can be easily treated by applying ice bags to the lesion. A hematoma or an ecchymosis resulting from serious injuries (eg head trauma) constitutes a medical emergency that requires the evacuation of blood collection.

Often times, hematomas and ecchymoses are diagnosed in the same clinical picture: the border between one lesion and another is often thin, to the point of not distinguishing bruising from hematoma.