Welling under the thick protein keratin layer on my father’s toenail was an expanding pool of blood. As the pressure mounted, the swelling caused pain. I will never forget as he took a drill bit from his toolbox, held it confidently in one hand, and twisted the threaded metal between his fingertips. Manually, he bore a minuscule hole into the matrix of the nail, releasing the blood under it. The hard lump was a subungual hematoma covered by the shield of his big toe; one of many forms of this complaint.
Found a Hard Lump of Blood? Maybe It’s a Hematoma
A hematoma is a type of internal bleeding. Unlike another type of internal bleeding, a hemorrhage, that bleeds without clotting, hematomas are characterized by their clots. A weak blood vessel wall forms edema (or Oedema), an abnormal accumulation of fluid in tissues within the body, of clotted blood.
Images of a Lump Under the Skin: Hematoma or Bruise?
Bruises and hematomas result when an injury breaks blood vessels and plasma flows out. In both cases, this causes skin discoloration and traps blood below the skin’s surface.
However, the vessels that cause each are different.
Bruises happen as capillaries burst. Hematomas result from larger blood vessels having structural integrity issues.
Ones that present as a lump under the skin are called subcutaneous hematomas. When it is visible, it presents as a red, liquid-filled mass.
Complications of a Lump on the Leg—Is it a Hematoma?
A lump on the leg is normally a very harmless hematoma requiring some basic first aid care. The first lesson of neophyte caretakers applies as a standard of care here: R-I-C-E. This acronym prescribes a sequence to lessen symptoms: rest – ice – compression – elevation. With this type of trauma, the main balance is giving enough rest and retaining enough flexibility in the injured area while healing.
However, there can be grave aggravations of a hematoma on the leg. Fibrous bands of tissue surrounding muscles create an inflexible area. This area is unable to stretch as swelling increases. Normal functioning of the muscles and nerves in the area is compromised. This is called compartment syndrome. If not dealt with, it can cause permanent damage.
In extreme cases, a surgery called a fasciotomy is required. The surgeon has to release the pressure in muscle tissue by filleting open the sinewy tissue restricting the area.
Other Types of Hematoma
There are more versions of hematoma than a hard lump on the leg. Hematomas occur in any tissue in the body. In serious cases, the pooling liquid can put pressure on nerves, organs, other tissues. When large enough they can displace organs, cause shock, and require surgery.
Other types of hematoma are:
- Intra-stomach: fluid collects in the stomach causing peritonitis Intramuscular: blood collected between muscle layers, swelling can be very painful.
- Septal: may materialize after nose injuries
- Ear: inside the slim covering between epidermis and cartilage
- Scalp: occurs on the outside of the skull, usually near the temple
- Subcutaneous: beneath the skin membrane
- Subungual: between nail bed and nail matrix
The most dangerous types affect the brain -epidural, subdural, and intracerebral. These bleeds are inside the shell of the skull. As the pooled blood traps between the thick calcium of our protective skeleton and the delicate structures of our cerebral organ, there is a lot of danger. Swelling here can affect the brain permanently and imminently if not treated as an emergency.
Diagnosis of Hematoma
Hematomas are classified by the position and area. Small dots less than 3 millimeters in diameter are called petechiae. Purpura are the next size up, less than 10 millimeters. Ecchymosis has a diameter greater than 10 millimeters.
Most hematomas don’t require medical attention. However, when they do, they are quite serious. For some of the more serious versions, doctors will test using an MRI (magnetic resonance imaging) or CT (computerized tomography) for the brain, an X-ray for bone fractures, and ultrasound for pregnancy complications.
Treatment for Hematoma
Despite pictures of severe hematomas, for the majority, there is little need for medical attention. Hematomas have a tendency to fix themselves with time. The lump will become more compressible. The blood is reabsorbed and the shape flattens. As with a bruise, the myriad of healing purple, green colors will change with time.
Remember that there is a likelihood of infection. The hematoma is filled with old blood that leaked from vessels previously. This old hematoma has no blood supply itself and therefore nothing cleansing the toxins in the liquid. So, keep an eye out for bacterial infection.
For the more severe forms of this injury, seek medical attention as soon as possible and frequently if symptoms persist. Some treatments for persistent and chronic hematoma include massage and rehabilitation.
Blood thinners can contribute, which is why there is an increased risk for the elderly.
Medications that can make hematoma more likely or more severe are:
- Apixaban (Eliquis)
- Warfarin (Coumadin)
- Clopidogrel (Plavix)
- Prasugrel (Effient)
- Rivaroxaban (Xarelto)
The following may lead to hematomas:
- Finger infections
- Ankylosing spondylitis
- Hepatitis C
- Aplastic anemia
- Alcohol use disorder
- Vitamin D deficiency
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