HEMATOMAS: CLASSIFICATION

Hematoma: symptoms

More often than not, the hematoma is the expression of a blunt trauma which, while not causing skin wounds, damages a blood vessel: inevitably, in such circumstances, 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 takes on a more 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 impaired blood coagulation, leukemia, surgery and anticoagulant therapy.

Classification of hematomas

Hematomas are classified into:

SUBCUTANEOUS HEMATOMES: Generally minor, 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 pinpoint spots on the skin, often caused by a lack of some coagulation elements. These are microhematomas, the diameter of which does not exceed 3 mm.
PURPLE: the hematoma typical of purpura is larger than petechiae, but smaller than ecchymoses. In general, purpura (from the English purpura) causes small purplish bruises on the skin, which do not clear up with acupressure. The diameter of these lesions is between 3 mm and 1 cm.
ECCHIMOSIS: another variant of subcutaneous hematomas of modest entity, caused by trauma, therefore bumps or blows. Even in ecchymosis, the hematoma is limited to the affected site: blood extravasation is therefore limited. The diameter of the hematoma generally exceeds one centimeter: even if it falls into the category of "mild" hematomas, ecchymosis is a more important hematoma than petechiae and purpura. Bruising can also be associated with heavy bruising, fractures or internal bleeding.

BRAIN HEMATOMES:

CEPHALOHEMATOMA: 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. The cephalohematoma probably originates from trauma during childbirth.
EPIDURAL HEMATOMA: it is an accumulation of blood in the space between the skull and the dura mater. Epidural hematoma is classified into two variants: intracranial (the more complicated form of head injury: it requires immediate surgery) and spinal (can occur spontaneously or after trauma).
SUBDURAL HEMATOMA (or subdural haemorrhage). Following a traumatic brain injury, blood pouring into the subdural space (between the arachnoid and dura mater) causes subdural hematoma.
SUB ARACHNOID HEMATOMA (subarachnoid hemorrhage): this is a hematoma that developed in the arachnoid space, between the arachnoid and pia mater. Most of the time, this form of hematoma arises from a ruptured brain aneurysm or a head injury. The characteristic symptoms onset suddenly: typical are headache (called "thunder rumble"), confusion, loss of consciousness, vomiting and convulsions. Imaging tests, associated with CSF analysis (by means of rachicentesis), X-ray cerebral angiography with contrast medium and electroencephalogram can ascertain the suspicion of subarachnoid hematoma. Subarachnoid hemorrhage also requires immediate surgical intervention. After evacuating the hematoma, the prevention of complications is essential.
SUBGAL HEMATOMA (or hemorrhage): the hematoma forms superficially, in the space between the periosteum (connective membrane covering the bones, therefore) 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).

The so-called "cauliflower ear", possible complication of some bruises in the ear, very common among wrestlers. EAR HEMATOMA (otohematoma or perichondral hematoma): the "hematoma of the ear" threatens the blood circulation at the level of the underlying cartilage. of connective tissue underlying the cartilage).

PERIANAL HEMATOMA: it is a type of hematoma that develops inside or near the anus. It is not uncommon for anal hematoma to be mistaken for external hemorrhoid. Again, the perianal hematoma originates from a rupture of small veins that drain blood from the anus. Rupture of the vessels can be triggered by violent coughing, weight lifting, exaggerated exertion, violent visceral movements.

SURGICAL WOUND HEMATOMA: hematoma can be a complication of a surgical wound. In similar circumstances, hematoma can form after a few hours after surgery, or late. The onset of post-surgery hematoma can be favored by some factors: alteration of coagulation, arterial hypertension, anticoagulant therapy and incomplete haemostasis (due to a lack of surgical technique). Recall that post-surgery hematoma greatly increases the risk of wound infection.

Similar hematomas can also be very dangerous: developed in the neck, for example, hematomas can heavily compress the trachea, also determining a poor prognosis. In this sense, immediate intervention (which consists in reopening the wound and evacuating the hematoma) is the only possible life-saving treatment.

SUB NAIL HEMATOMA: somewhat painful and unpleasant, the sub nail hematoma originates from a crushing of the nail. It is advisable to drain the hematoma by drilling the nail. Despite being very painful, nail hematoma is not a medical emergency.
Removal of the nail can also be an effective treatment to speed up the healing time of the hematoma.