Ecchymosis vs hematoma: An Overview
Both ecchymosis and hematoma are medical terms for what is commonly known as bruises [1].
Ecchymosis is a flat skin discoloration caused by blood leakage into the tissue [2].
It originates from capillary rupture and is superficial [2], limiting itself to the dermis and subcutaneous tissue [3].
Ecchymosis is mostly painless and can be traumatic [2] or non-traumatic, like in slapped cheek syndrome (5th disease) [3].
On the other hand, a hematoma is a localized collection of blood involving larger vessels. It can occur in deeper regions of the body, not only the skin [4].
Hematomas are often painful and can lead to functional impairment at their location [5].
They originated mostly from kinetic [6] or mechanical trauma [7].
Ecchymosis: A closer look
Ecchymosis is a medical term for a common bruise. It is a discoloration of the skin that is larger than 1 cm [1, 2].
The mechanism behind ecchymosis is vessel injury caused by an impact. The force that hits the blood vessels cracks them open, leading to a blood leak, which gives the characteristic bruising colors [2].
Ecchymosis can be blue, black, or purple [2].
No special locations of ecchymosis exist. It can happen anywhere, like on the skull, abdominal wall, legs, or groin [1].
However, ecchymosis can also arise due to other factors like disease or medications [3].
What causes ecchymosis?
The typical cause of ecchymosis is a blow or hit injury, which is strong enough to burst a vessel [2].
Some substances can increase the likelihood of ecchymosis. Common medications that have such an effect are:
- warfarin,
- corticosteroids,
- antibiotics [2].
Also, supplements like ginkgo biloba can lead to frequent occurrences of ecchymosis [2].
Further, also many diseases can contribute to more ecchymosis. For instance, vitamin B12 anemia can present with ecchymosis [8]. Another example is chronic venous insufficiency, which can lead to localized ecchymosis in the legs [9].
Additionally, more than 27 conditions can cause light ecchymosis [2].. Just to name a few, it can be a sign of amyloidosis and neuroblastoma.
What is a hematoma?
A hematoma is a local collection of blood outside of the vessels. It can be in the skin, tissues, or organs [4].
Places where hematomas can occur include the brain [11], muscles [12], the abdomen [13] or the penis [14].
The primary cause of hematomas is trauma. However, hematomas can also occur after surgeries and in vascular anomalies [4].
A characteristic of a hematoma is that the vessel injury bleeding often results in tender blood clots, pain, and swelling [5, 15].
Similarly to ecchymosis, certain conditions can also increase the likelihood of hematoma formation [16, 4]. In some cases, hematomas can also occur spontaneously [13].
Most hematomas are self-limited and resolve on their own. However, there are exceptions that demand medical attention. For example, hematomas in the brain [11] or hematomas that are caused by continuous bleeding [14].
What causes hematoma?
The most common cause of hematoma is injury to the vessel [4].
The vessel can be injured due to physical trauma. A blunt object, such as a kick to the leg, can cause such an injury. However, it can also result from a blow coming from kinetic energy transmission, like in falls or road accidents [5, 17, 6].
Hematomas can also occur as a complication of surgery. For instance, they can happen after hip replacement surgery or augmentation mammaplasty [5, 7, 18].
Many conditions exist that can increase the chances of getting a hematoma. Among them are:
- thrombocytopenia
- alcohol abuse,
- anemia,
- vitamin D deficiency,
- HIV,
- hepatitis C [5].
Also, medications that affect the blood can increase the risk of hematomas. These drugs include
Additionally, hematomas can also happen without any recallable reason. In such cases, they are called spontaneous hematomas [19].