Hematoma vs Bruise: How to Tell the Difference

Both hematomas and bruises occur when blood vessels break and blood leaks into the surrounding tissues. But bruises and hematomas are not the same thing. Please continue reading to learn the key differences between a bruise and a hematoma.

What is a hematoma?

A hematoma is a collection or pool of blood outside a blood vessel. It occurs due to a large leakage of blood, for example, following a severe injury. Possible causes and risk factors for hematomas include aneurysms (a bulging or weakness in a blood vessel wall), head injuries, orthopedic injuries, use of blood thinning medications, and certain viral infections.

There are different types of hematomas depending on the location. For example, a subdural hematoma develops when blood collects below the dura mater, a membrane between the brain and skull. An epidural hematoma develops between the skull and dura mater. Other types of hematomas include spinal hematomas in the spine, hepatic hematomas in the liver, subdermal hematomas in the skin, and subungual hematomas in the nail beds.

Symptoms of a hematoma depend on the location. For example, superficial hematomas in the skin can cause redness, tenderness, pain, warmth, swelling, and inflammation. People with serious hematomas, such as a subdural hematoma as a result of a head injury, can have severe hematoma symptoms such as headache, drowsiness, nausea, vomiting, slurred speech, confusion, vision changes, seizures, and coma.

The RICE method (rest, ice, compression with an elastic bandage, and elevation) is usually all that is needed to control pain and reduce swelling if there is a superficial hematoma involving the skin. On the other hand, intracranial hematomas in the skull require immediate medical attention and urgent care, including surgical drainage.

What is a bruise?

A bruise, also called a contusion or ecchymosis, is a red, blue, black, or purplish color mark on the skin. It develops due to a small leakage of blood from the capillaries (tiny blood vessels).

Possible causes of bruises include minor accidents such as bumps, trips, slips, and falls, as well as more serious injuries and physical trauma. Additionally, bruises can develop after blood draws, following cupping treatments, and in thinning skin due to age. People who take certain medications such as blood thinners, nonsteroidal anti-inflammatory drugs like aspirin, corticosteroids, certain antibiotics, and supplements like omega-3 fatty acids and Ginkgo biloba may be more prone to bruising. Bruises can form in association with certain health conditions, such as vitamin deficiencies or conditions that affect the platelets—platelets are necessary for blood clotting—such as hemophilia, leukemia, and certain autoimmune disorders.

Bruise symptoms include pain, tenderness, soreness, skin discoloration, and swelling. It is normal for the bruised area to change color as the body heals the small blood vessels in the injured area. Doctors recommend the RICE protocol (rest, ice, elevation, and compression with elastic bandages) for bruises. Placing an ice pack, cold compress, or a bag of frozen peas on a bruised area can help with pain and swelling. You can also take an over-the-counter painkiller such as acetaminophen (Tylenol) to manage pain.

Most people can diagnose a bruise themselves, or a doctor can do so with a physical exam. Bruises usually go away on their own in about two weeks without medical care. However, unexplained and recurrent bruises can be a sign of an underlying medical problem. If you have suffered physical trauma and have a severe bruise, your doctor may order X-rays to rule out broken bones. If you have recurrent and unexplained bruising, your doctor may order a blood test to check for a bleeding disorder.

Do hematomas look like bruises?

Both hematomas and bruises develop due to blood leaking from damaged blood vessels. However, they do not look similar.

Hematomas in the brain and other organs are not visible. A large hematoma under the skin’s surface can be a localized area of pain and tenderness. It is typically a raised solid mass that feels firm or spongy. Hematomas take longer to heal and may continue to get larger if there is active bleeding.

On the other hand, a bruise is usually flat and causes skin discoloration. It may or may not be tender. Bruises tend to fade gradually over a period of two weeks.

Are hematomas and blood clots the same thing?

No, hematomas and blood clots are not the same thing. A hematoma develops when blood collects outside a blood vessel. A blood clot forms when platelets and fibrin clump together. Blood clots are necessary to stop bleeding when blood vessels are damaged. However, if a blood clot forms inside an intact blood vessel, it can be very dangerous because it can block blood flow to a vital organ such as the heart, lungs, or brain.

How do you rule out a hematoma?

If a healthcare professional suspects an intracranial hematoma (inside the skull), they will order imaging studies such as a CT scan, MRI, or angiogram to rule out a hematoma. If a hematoma is present, they can use these imaging modalities to determine its position and size and decide if it will require surgical drainage.

How do you know if a bruise or hematoma is serious?

You can tell that a bruise or hematoma is serious and requires medical attention if:

It keeps getting bigger after the injury.
The affected area makes your arm or leg feel tight or swollen.
It lasts longer than 2 weeks.
It appears without a known injury or reason.

What looks like a bruise or hematoma but isn’t?

Different types of bleeding in the skin can look similar:

Bruise: A small leakage of blood that causes skin discoloration. It is a flat blue or purple patch and may be tender. Bruises change color as they heal.
Hematoma: A large leakage and pooling of blood following major trauma, such as car accidents or falls. A hematoma in the internal organs is not visible. A hematoma under the skin is usually raised and tender to the touch.
Purpura: A small area of bleeding under the skin that appears like a reddish or purple spot. Purpura are smaller than bruises but larger than petechiae.
Petechiae: Pinpoint areas of bleeding less than 2 millimeters in size that appear as reddish dots in the skin and don’t blanch (turn white) with pressure.

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