traumatology

Hematomas: classification

There are multiple variants of hematoma, classified essentially on the basis of the severity and location of the trauma suffered.

Hematoma: symptoms

More often, the hematoma is the expression of a blunt trauma that, while not causing cutaneous wounds, damages a blood vessel: inevitably, in similar circumstances, the blood spills from the blood vessel to the surrounding tissue, accumulating and creating a bruise, known as hematoma.

From what has been said, it is understandable that a hematoma caused by the rupture of a small subcutaneous capillary generates minor damage. When the hematoma originates from a rupture of a larger caliber vessel, the lesion has the most important pathological significance.

  • Let us briefly recall that not all hematomas are caused by trauma: in the introductory article we have in fact distinguished "traumatic" hematomas from those triggered by other causes, such as alteration of blood coagulation, leukemia, surgery and anticoagulant therapy.

Classification of hematomas

Hematomas are classified into:

  1. SUBCUTANEOUS HEMATOMAS : generally mild, these lesions tend to resolve in a few days or, at most, in a couple of weeks. In such circumstances, the bleeding generally remains confined to the surrounding tissues, which repair the lesion. In turn, subcutaneous hematomas are classified into three categories:
  • PETECCHIE: small hyperpigmented punctate spots on the skin, often caused by a lack of some coagulation elements. These are microhematomas, whose diameter does not exceed 3 mm.
  • PURPLE: the typical hematoma of the purpura is larger than the petechia, but smaller than the bruising. In general, purpura (from English purpura ) causes small purple hematomas on the skin, which do not lighten by acupressure. The diameter of these lesions is between 3 mm and 1 cm.
  • ECCHIMOSIS: another variant of subcutaneous hematoma of modest entity, caused by trauma, therefore bumps or barrel. Even in ecchymosis, the hematoma is limited to the affected site: blood extravasation is therefore limited. The diameter of the hematoma generally exceeds the centimeter: even if it falls into the category of "mild" hematomas, ecchymosis is a more important hematoma than petechia and purpura. Ecchymosis may also be associated with consistent hematomas, fractures or internal bleeding.
  1. BRAIN HEMATOMES :
  • CEPHALOEMATOMA: typical of newborns. This variant of hematoma is rather subtle: the hematoma, although originating at birth, spreads slowly and completely asymptomatically. After a few days, the phenomenon becomes evident. Cephalohematoma probably originates from trauma during childbirth.
  • HEPIDURAL HEMATOMA: an accumulation of blood in the space between the skull and dura mater. Epidural hematoma is classified into two variants: intracranial (the most complicated form of head injury: requires immediate surgical intervention) and spinal (may occur spontaneously or after a trauma).
  • SUBDURAL HEMATOMA (or subdural hemorrhage). Following a traumatic brain injury, the blood, pouring into the subdural space (between arachnoid and dura mater), causes a subdural hematoma.
  • HEMATOMA SUB ARACNOIDEO (subarachnoid hemorrhage): it is a hematoma developed in the arachnoid space, included between arachnoid and pia mater. Most often, this form of hematoma originates from the rupture of a brain aneurysm or from a head injury. The characteristic symptoms arise suddenly: typical are headache (called "rumbling thunder"), confusion, loss of consciousness, vomiting and convulsions. Imaging tests, associated with liquor analysis (using rachicenthesis), X-ray cerebral angiography with contrast medium and electroencephalogram can ascertain the suspicion of a subarachnoid hematoma. Subarachnoid hemorrhage also requires immediate surgical intervention. After evacuating the hematoma, prevention of complications is essential.
  • HEMATOMA (or hemorrhage) SUBGALEAL: the hematoma is superficially formed, in the space between the periosteum (connective membrane covering the bones, then) and the aponeurotic galea (dense fibrous tissue that covers the upper part of the skull, is one of the five layers that make up the scalp).
  1. The so-called "cauliflower ear", a possible complication of some haematomas in the ear, very common among wrestlers. HEMATOMA EAR (otohematoma or perichondral hematoma): the hematoma to the ear threatens the blood circulation at the level of the underlying cartilage. After a trauma here, the blood escapes from the vessels to flow between the cartilage and the auricular perichondrium (membrane of connective tissue underlying the cartilage).
  1. PERIANAL HEMATOMA : it is a type of hematoma that develops internally or near the anus. It is not uncommon for anal hematoma to be mistaken for external hemorrhoid. Also in this case, the perianal hematoma originates from a rupture of small veins that drain the blood from the anus. The rupture of the vessels can be triggered by violent coughing, lifting weights, exaggerated strains, violent visceral movements.
  1. HEMATOMA FROM SURGICAL HERITAGE : the hematoma can be a complication of a surgical wound. In such circumstances, the hematoma may be formed a few hours after surgery, or belatedly. The appearance of the post-surgery hematoma can be favored by some factors: alteration of the coagulation, arterial hypertension, anticoagulant therapy and incomplete haemostasis (due to a defect in the surgical technique). Recall that the post-intervention hematoma greatly increases the risk of wound infection.
    Similar hematomas can also be very dangerous: developed at the level of the neck, for example, hematomas can heavily compress the trachea, resulting in a poor prognosis. In this sense, immediate intervention (consisting in reopening the wound and evacuating the hematoma) is the only life-saving treatment possible.
  1. HEMATOMA SUB UNGUEALE : somewhat painful and unpleasant, the sub ungueale hematoma originates from a crushing of the nail. It is advisable to drain the hematoma by drilling the nail. Despite being very painful, the nail hematoma is not a medical emergency.

    Even the removal of the nail can be an effective treatment to speed up the healing time of the hematoma.