Hematoma vs. Ecchymosis: Differences and Similarities

Picture of a ecchymosis.

• A hematoma is defined as a solid swelling of clotted blood within the body’s tissues.
• Ecchymosis is a skin discoloration that results from bleeding underneath the skin and usually larger than 1 cm or .4 inches.  
• A bruise is a discolored skin area that is caused by a blow, impact or suction (suction bruise) that ruptured underlying small blood vessels. 
• Sometimes, hematoma and ecchymosis are used interchangeably leading to some confusion between the two terms and others like 
  • contusion (bruise), 
  • petechiae (tiny purple, red or brown spots in the skin due to tiny blood vessel breakage), and 
  • purpura (purple spots in the skin due to small vessel bleeding).

Can You Fly with a Hematoma or Ecchymosis?

• Flying may increase the risk of developing a pulmonary embolism or DVT (deep vein thrombosois).
• Some doctors suggest you wait about 4 weeks after a hematoma or ecchymosis resolves to resume flying.
• Consult your doctor for advice.
   

Differences Between the Signs and Symptoms of Hematoma vs. Ecchymosis

• Skin discoloration that occurs without trauma and is relatively flat is usually considered to be ecchymosis while hematoma symptoms mainly depend on its size and location. 
• Ecchymosis is, by definition, visible and is usually not palpated as a mass. 
• Visible skin discoloration (including redness and swelling) only occurs in some hematomas while many others are not visible if they occur in such locations as the abdomen or brain. 
• Symptoms of hematoma are related to the organ system where it is located, for example, neurologic problems if located in the brain or abdominal pain if located in the abdomen.
• Other hematoma types, for example, internally, may be palpated or felt like a spongy mass and are not visible depending on its location. 
• Hematomas after the hitting head (subdural for example) are not palpable as compared to a superficial elevated bruise or "goose egg on shin".

Similarities Between the Signs and Symptoms Hematoma vs. Ecchymosis

Symptoms and signs shared by some hematomas (superficial types) and ecchymosis are 

• pain, 
• inflammation, 
• mild swelling (mild edema), and
• warmth at the site and skin discoloration. 

You should see a doctor if a hematoma or ecchymosis get bigger because after day 1 they occur after 

• Trauma to the head.
• Trauma to the abdomen
• If it occurs near the eye and vision is altered

Hematomas last for about 2 weeks and/or they reoccur. Hematomas make your arm or leg swollen or tight, they are suspected or caused by a sprain or bone fracture.

Both hematoma and ecchymosis may be caused by traumatic injury but hematomas are usually due to more severe trauma resulting in larger blood vessel breakage and can be complications that occur after surgery (for example, hematoma after C-section). 

Ecchymosis, unlike bruises and hematomas, often have many other causes than trauma. For example, ecchymosis may be caused by problems with 

• blood vessels, 
• blood clotting factors, 
• platelets, and several medicines like 
• blood thinners, 
• steroids, 
• NSAID's or nonsteroidal anti-inflammatory drugs like ibuprofen (Advil, Infant’s Ibuprofen), and 
• many others. 

These factors may occasionally contribute to hematoma development or size increase, too.

• Types of hematomas. There are two major types of hematomas, superficial (visible) and internal (mainly not visible but may be palpable or detectable by tests like CT scan and MRI). 
• Type of ecchymosis. Ecchymosis has one major type and it is visible. 
• Subtypes of hematomas and ecchymosis. Both hematomas and ecchymosis have subtypes. These subtypes are named mainly by the area of the body where they are found. 
• Examples of superficial hematomas and ecchymosis are:
  • Eye, periorbital, eyelid or facial hematoma or ecchymosis
  • Vaginal, scrotal or penile hematoma or ecchymosis
  • Head, arm or leg hematoma or ecchymosis
  • Subcutaneous, spontaneous, 
  • Senile (age-related), infant 
• Superficial hematomas and ecchymosis usually go through visible stages as they heal. 

These stages are approximate and based on coloration based on breakdown of hemoglobin to bilirubin. Age of the ecchymosis is:

• Day 1 is reddish
• Days 2 through 5, bluish/purple.
• Days 5 through 7, green and or yellow.
• Days 7 through 10 days, brown
• Days 10 through 14 days, normal skin color.
• Weeks 2 through 4 weeks: Hematomas usually take more time to resolve these stages than ecchymosis. You may develop an itchy hematoma due to bilirubin production.

Subtypes of Internal Hematomas

• The subtypes of internal hematomas are also named after the body site they occupy. For example,
  • Brain hematoma
  • Subdural hematoma
  • Intracerebral hematoma
  • Kidney hematoma
  • Abdominal hematoma
• These subtypes can cause serious problems and may require surgical drainage.
• Ecchymosis, by definition, does not have non-visible internal subtypes.

You should see a doctor if either one of these two conditions get bigger in size because after day 1 they occur after 

• trauma to your head, trunk or abdomen
• if they occur near the eye and your vision is altered
• they last for about 2 weeks and/or they reoccur
• they make your arm or leg swollen or tight
• they are suspected or caused by a sprain or bone fracture

• your doctor 
• by your history, 
• a physical exam, and
• family history and examination of your medications. 

First-Aid Treamtent for Hematoma and Ecchymosis

• Bruises, small hematomas and ecchymosis may self-resolve but a hematoma will take a longer time to resolve. Superficial hematomas and ecchymosis (and some bruises) may be treated with 
  • cold compresses, 
  • rest, 
  • light compression, and 
  • acetaminophen (Tylenol and others). 
• Contact a doctor if you think that you have broken a bone (fracture), if the lesion enlarges, or if you have any questions about home management of hematomas and ecchymosis.

Medical Treatment for Hematomas and  Ecchymosis

Small Hematoma Treatment

• Bruises and small hematomas may resolve on their own, but a hematoma will take a longer time to resolve. Some hematomas (and some bruises) may be treated with cold compresses, rest, light compression, and Tylenol. 

Large Hematoma and Ecchymosis Treatment

• Large hematomas can cause significant amounts of blood loss that can threaten the patient by causing low blood pressure and can displace or otherwise damage organs, for example, a subdural hematoma. Such hematomas may need surgical intervention including drainage.
• Some individuals with ecchymosis may respond to such supportive treatment minus surgery for ecchymosis; however, many individuals need to have an underlying cause treated to reduce or stop both areas of skin ecchymosis and development and/or enlargement of hematomas. 

Questions to You Ask Your Doctor about Hematomas and Ecchymosis

• Here are some sample questions ymay want to ask your doctor:
  • Why is my hematoma (or ecchymosis) not healing?
  • What does the color of a hematoma (or ecchymosis) mean?
  • How long will it take to remove or resolve a hematoma (or ecchymosis)?
  • If I home treat a hematoma or ecchymosis, what can signal improvement?
  • Why am I going to surgery for a hematoma?

• The prognosis for small superficial hematomas and most ecchymosis is good as they usually heal on their own.
• Internal hematomas have a fair to worse prognosis if the hematoma damages brain or internal organs, and even death.  
• Ecchymosis due to underlying causes (for example, bleeding disorders) range from good to poor. 

• Some hematomas and ecchymosis caused by trauma can be prevented by avoiding risky sports and/or wearing protective gear. 
• Treating underlying conditions may slow or prevent some acerbations of ecchymosis and may reduce or stop some hematoma formation and may reduce the hematoma size.
• Hematomas and ecchymosis related to genetic problems usually cannot be prevented.