From the Guidelines
Yes, a hematoma can present as a hard and tender lump without signs of bruising. When blood collects under the skin or in deeper tissues following an injury, it can form a firm mass that feels tender to touch, as noted in the management of cannulation complications 1. While hematomas often cause discoloration (bruising), this isn't always the case, especially with deeper hematomas where the blood collection occurs beneath layers of tissue that hide the discoloration. The absence of bruising is more common in deep hematomas that form in muscle tissue or around organs rather than superficial ones just under the skin. The hardness occurs because as blood collects outside blood vessels, it begins to coagulate and form a clot, creating a firm texture, which can potentially compress the vessel, resulting in thrombosis of the AV access 1. If you discover a hard, tender lump without bruising, especially after trauma or injury, it's essential to seek medical evaluation, particularly if the lump is growing, extremely painful, or located in a concerning area. Some key points to consider about hematomas include:
- They can develop as a result of an infiltration of the vein or due to leaking of blood around the puncture site during cannulation, during a dialysis treatment, or after removal of a needle at the end of a dialysis treatment 1.
- The size of hematomas can vary significantly, from a small diffuse area to a large, firm mass 1.
- Pain of various degrees is common and can occur in various sites, at various times, and with various intensity, and management of cannulation complications such as infiltration and resulting hematoma is dependent on the extent of swelling, pain, and patient anxiety 1. Given the potential complications, such as thrombosis or stenosis at the site of hematoma, it is crucial to prioritize medical evaluation to determine the appropriate course of action for a hematoma presenting as a hard and tender lump without bruising.
From the Research
Hematoma Characteristics
- A hematoma can present as a hard and tender lump, but the provided studies do not directly address the relationship between hematoma hardness, tenderness, and the absence of bruising 2, 3, 4, 5, 6.
- The studies focus on the effects of nonsteroidal anti-inflammatory drugs (NSAIDs) on hemostasis, the evaluation of soft-tissue hematomas using contrast-enhanced ultrasound, and the association between NSAIDs and operative bleeding in the perioperative period.
Ultrasound Evaluation of Hematomas
- A study on the ultrasound evaluation of musculoskeletal hematomas found that the sonographic appearance of a hematoma is unrelated to its age, and a hypoechoic appearance is easier to aspirate than hematomas with other echotextures 5.
- Another study used contrast-enhanced ultrasound to detect active hemorrhage in patients with soft-tissue hematomas, but it did not specifically address the characteristics of hematomas without signs of bruising 3.
NSAIDs and Hematoma Risk
- Several studies investigated the risk of hematoma formation associated with NSAID use in various surgical procedures, including plastic surgery, and found no significant difference in the incidence of bleeding or hematoma formation between NSAID and non-NSAID groups 4, 6.
- These studies suggest that NSAIDs are unlikely to be the cause of postoperative bleeding complications, but they do not provide information on the physical characteristics of hematomas, such as hardness and tenderness, or the absence of bruising.