Surgery Book



Aka: Contusion, Bruise, Soft Tissue Hematoma, Subcutaneous Hematoma, Subepidermal Hemorrhage, Bruising, Hematoma
  1. See Also
    1. Subcutaneous Hematoma Drainage
    2. Musculoskeletal Injury
    3. Purpura
    4. Bleeding Disorder
    5. Contusion
    6. Vascular Skin Reaction
  2. Pathophysiology
    1. Blunt injury disrupts soft tissue (skin, Muscle) capillaries and venules, resulting in Hemorrhage into local interstitial tissue
  3. Risk Factors
    1. Bleeding Disorder
    2. Connective Tissue Disorder (e.g. Ehlers-Danlos Syndrome)
    3. Systemic Corticosteroids
    4. Cushing's Disease
  4. Exam
    1. Does not blanch on pressure
      1. Contrast with a Vascular Skin Reaction (Erythema Multiforme, Urticaria) which does blanch
      2. Compare with Purpura or Ecchymosis which like a Contusion does not blanch
    2. Color (unreliable as an indicator of injury timing)
      1. Days 0-2: Swelling and tenderness
      2. Days 2-5: Red, blue or purple coloration
      3. Days 5-7: Greenish hue
      4. Days 7-10: Yellow appearance
      5. Days 10-14: Brown discoloration
      6. Days 14-32: Clear appearance
    3. Evaluate associated injuries
      1. Include examination of joint above and below the involved joint
      2. Include sensory, motor and vascular exam
      3. Include skin and compartment exam
      4. Mallon (2013) Shoulder Disorders, EM Bootcamp, Las Vegas
  5. Differential Diagnosis
    1. Purpura or Ecchymosis
      1. Non-Traumatic lesions that also do not blanch on pressure
  6. Precautions
    1. Always evaluate for more significant underlying injury
      1. Fracture
      2. Vascular compromise
      3. Neurologic deficit
      4. Compartment Syndrome
      5. Tendon rupture
      6. Ligament tear with joint instability
    2. Unexplained Bruising may be a sign of Child Abuse, Domestic Abuse or Elder Abuse
      1. Consider in Bruising outside of bony prominences (e.g. lateral arms, face, back)
  7. Management
    1. RICE-M
    2. Subcutaneous Hematoma Drainage
  8. Complications
    1. Associated more significant injury (see precautions above)
    2. Compartment Syndrome
    3. Myositis Ossificans
      1. Ossification or calcification of muscle Hematoma
    4. Local pressure tissue necrosis
    5. Decreased functional mobility (esp. elderly)
    6. Infection

Contusions (C0009938)

Definition (MEDLINEPLUS)

A bruise is a mark on your skin caused by blood trapped under the surface. It happens when an injury crushes small blood vessels but does not break the skin. Those vessels break open and leak blood under the skin.

Bruises are often painful and swollen. You can get skin, muscle and bone bruises. Bone bruises are the most serious.

It can take months for a bruise to fade, but most last about two weeks. They start off a reddish color, and then turn bluish-purple and greenish-yellow before returning to normal. To reduce bruising, ice the injured area and elevate it above your heart. See your healthcare provider if you seem to bruise for no reason, or if the bruise appears to be infected.

Definition (NCI) A bruise due to trauma.(NICHD)
Definition (NCI_CTCAE) A finding of injury of the soft tissues or bone characterized by leakage of blood into surrounding tissues.
Definition (NCI_FDA) A bruise; an injury of a part without a break in the skin.
Definition (NCI) Injury of the soft tissues or bone without breaking the skin that is characterized by blood leakage into the surrounding area.
Definition (MSH) Injuries resulting in hemorrhage, usually manifested in the skin.
Definition (CSP) mechanical injury (usually caused by a blow) resulting in hemorrhage beneath unbroken skin; a bruise.
Concepts Injury or Poisoning (T037)
MSH D003288
ICD9 924.9
ICD10 T14.8
SnomedCT 269380009, 360235001, 271938003, 157539008, 37808005, 157440008, 269363005, 125667009, 308492005, 77643000
LNC LA7423-2
English Bruise, Contusion of unspecified site, Bruise NOS, bruising, contusion (physical finding), contusion, Contusion NOS, Contusions [Disease/Finding], contused wound, contusions, bruised, bruise, contus, bruises, contused, Bruises, Bruise NOS (disorder), Bruise (contusion) - lesion, Bruise (contusion) - lesion (qualifier value), Contusion (morphologic abnormality), Bruise (finding), Contused wound, BRUISE, CONTUSION, Contusion, Bruising, Bruise - lesion, Contusion - lesion, Contusion (disorder), Contusion - lesion (morphologic abnormality), Contusion, NOS, Bruise - lesion (morphologic abnormality), Contusions
Portuguese EQUIMOSE, Contusão de ponto NE, Machucadura, Ferida contundida, Contusão, Contusões, Machucado
Dutch kneuzing op niet-gespecificeerde plaats, blauwe plek, gekneusde wond, kneuzing, Contusie, Contusies, Kneuzing
French Contusion d'un site non précisé, Bleu, Bleus, ECCHYMOSES, Meurtrissures, Plaie contuse, Contusion, Contusions
German Prellung an unspezifischer Stelle, blauer Fleck, blaue Flecken, QUETSCHUNG, Kontusion, Kontusionen, Prellungen, Quetschwunde
Italian Contusione di sede non specificata, Contusione, Ferita contusa, Contusioni
Spanish Cardenales, Contusión de localización no especificada, Cardenal, CARDENAL, magulladura, moretón, SAI (trastorno), Bruise NOS, cardenal, moretón (hallazgo), contusión (anomalía morfológica), moretón, lesión traumática contusa, moretón, SAI, contusión - lesión traumática, contusión - lesión traumática (calificador), cardenal, SAI, Herida contusa, contusión (trastorno), contusión - lesión (anomalía morfológica), contusión - lesión, contusión, Contusión, Contusiones, Magulladura
Japanese 部位不明の挫傷, ザショウ, ブイフメイノザショウ, 挫傷, ザソウ, ざ傷, 打撲, 打撲傷, 挫創
Swedish Blåmärken
Czech zhmoždění, Kontuze, Zhmožděnina, Zhmoždění, Kontuze blíže neurčeného místa, vulnus contusum, zhmožděná rána, Zhmožděná rána
Finnish Kontuusiot
Polish Zbicie, Stłuczenie
Hungarian Véraláfutás, Contusio, Nem meghatározott lokalizációjú zúzódás, Zúzott seb
Norwegian Blåmerker, Kontusjoner, Blodutredelser
Derived from the NIH UMLS (Unified Medical Language System)

Hematoma (C0018944)

Definition (NCI) A localized collection of blood, usually clotted, in an organ, space, or tissue, due to a break in the wall of a blood vessel.
Definition (NCI_NCI-GLOSS) A pool of clotted or partially clotted blood in an organ, tissue, or body space, usually caused by a broken blood vessel.
Definition (NCI_FDA) A localized collection of blood, usually clotted, in an organ, space, or tissue, due to a break in the wall of a blood vessel.
Definition (NCI_CDISC) A localized collection of blood, usually clotted, in an organ, space, or tissue, due to a break in the wall of a blood vessel.
Definition (NCI_CTCAE) A disorder characterized by a localized collection of blood, usually clotted, in an organ, space, or tissue, due to a break in the wall of a blood vessel.
Definition (MSH) A collection of blood outside the BLOOD VESSELS. Hematoma can be localized in an organ, space, or tissue.
Concepts Pathologic Function (T046)
MSH D006406
SnomedCT 211530002, 35566002, 385494008
LNC LA7439-8
French HEMATOME, Hématome SAI, Hématome
English HAEMATOMA, Haematoma NOS, Hematoma NOS, Hematoma, hematoma (physical finding), hematoma, Hematomas, Hematoma [Disease/Finding], haematoma, haematomas, hematomas, HEMATOMA, Haematoma, Hematoma (disorder), Hematoma (morphologic abnormality), Haematoma, NOS, Hematoma, NOS
Portuguese HEMATOMA, Hematoma NE, Hematoma
Spanish HEMATOMA, Hematoma NEOM, hematoma (anomalía morfológica), hematoma (trastorno), hematoma, Hematoma
German HAEMATOM, Haematom NNB, Haematom, Bluterguß, Hämatom
Dutch hematoom NAO, hematoom, Bloedbuil, Bloeduitstorting, Haematoma, Hematoom
Italian Ematoma NAS, Ematoma
Japanese 血腫, 血腫NOS, ケッシュNOS, ケッシュ
Swedish Hematom
Czech hematom, Hematom, Hematom NOS
Finnish Hematooma
Croatian HEMATOM
Polish Krwiak
Hungarian Haematoma, Vérömleny k.m.n., Haematoma k.m.n.
Norwegian Blodoppfylling i vev, Hematom
Derived from the NIH UMLS (Unified Medical Language System)

Subcutaneous hematoma (C0520532)

Concepts Acquired Abnormality (T020)
SnomedCT 5309003
Italian Ematoma sottocutaneo
Japanese 皮下血腫, ヒカケッシュ
English SUBCUTANEOUS HAEMATOMA, SUBCUTANEOUS HEMATOMA, subcutaneous hematoma, hematoma subcutaneous, Subcutaneous haematoma, Subcutaneous hematoma, Subcutaneous hematoma (disorder)
Portuguese HEMATOMA SUBCUTANEO, Hematoma subcutâneo
French HEMATOME SOUS-CUTANE, Hématome sous-cutané
Czech Podkožní hematom
Hungarian Subcutan haematoma
Spanish hematoma subcutáneo (trastorno), hematoma subcutáneo, Hematoma subcutáneo
Dutch subcutaan hematoom
German subkutanes Haematom
Derived from the NIH UMLS (Unified Medical Language System)

Haemorrhage subepidermal (C0854108)

Concepts Disease or Syndrome (T047)
Italian Emorragia subepidermica, Sanguinamento subepidermico
Dutch bloeding subepidermaal, subepidermale bloeding
German Blutung, subepidermal, Subepidermale Blutung, Blutung subepidermal
Spanish Hemorragia subepidermal, Sangrado subepidérmico, Hemorragia subepidérmica
Japanese 表皮下出血, ヒョウヒカシュッケツ
Czech Subepidermální hemoragie, Subepidermální krvácení
English Haemorrhage subepidermal, Hemorrhage subepidermal, Subepidermal bleeding
Hungarian Subepidermalis vérzés, Subepidermalis haemorrhagia
French Saignement sous-épidermique, Hémorragie sous-épidermique
Portuguese Sangramento subepidérmico, Hemorragia subepidérmica
Derived from the NIH UMLS (Unified Medical Language System)

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