How do you describe a circular round hematoma on a physical exam?

Describing a Circular Round Hematoma on Physical Examination

When documenting a circular or round hematoma on physical exam, describe it as "crescentic or circular thickening" with specific measurements of maximum thickness, location, and associated findings such as overlying skin changes or tissue pressure effects.

Key Descriptive Elements

Shape and Configuration

• Circular or crescentic morphology is the standard terminology used in medical documentation, particularly for intramural hematomas where this pattern is characteristic 1
• The term "circular thickening" specifically applies when the hematoma forms a complete ring around a structure, while "crescentic" describes a crescent-shaped or partial circular pattern 1

Essential Measurements

• Document maximum thickness in millimeters or centimeters—this is critical as thicknesses ≥7 mm have clinical significance in certain contexts (e.g., intramural hematomas) 1
• Record the diameter of the circular hematoma at its widest point 1
• Note the longitudinal extent if the hematoma extends along a structure 1

Location Specificity

• Precisely document the anatomical location using standard anatomical terminology 1
• For extremity hematomas, specify the exact region (e.g., "posteromedial aspect of the lower thigh") 2
• Note whether the hematoma is superficial or deep within the tissue planes 3

Associated Physical Findings

• Overlying skin changes: Document any discoloration, warmth, or signs of necrosis, as increased tissue pressure from hematomas can cause skin necrosis 3
• Tissue tension: Assess and document whether the area feels tense or fluctuant on palpation 3
• Tenderness: Note the degree of pain or tenderness on palpation 1
• Pulse examination: Check and document distal pulses if the hematoma is in an extremity 1

Temporal Context

• Document whether this is an acute presentation (hours to days) or chronic (weeks to months), as chronic expanding hematomas can mimic malignancies 2, 4, 5
• Note any history of trauma, surgery, or anticoagulation that preceded the hematoma formation 6, 5

Clinical Pitfalls to Avoid

• Do not assume all circular masses are benign hematomas—chronic expanding hematomas can clinically and radiologically mimic soft tissue sarcomas and require imaging confirmation 4, 5
• Assess for compartment syndrome risk: Large hematomas, particularly in extremities, can cause increased tissue pressure leading to ischemia and necrosis even without frank compartment syndrome 3
• Document "unusual" features: Non-circular hematoma shapes, disproportionate edema, or unusual locations may suggest underlying pathology such as vascular malformations or tumors 1, 7

Documentation Example Format

A complete description should include:

• Shape: "Circular" or "crescentic"
• Size: Maximum diameter and thickness in cm/mm
• Location: Precise anatomical location
• Consistency: Firm, fluctuant, or tense
• Overlying skin: Normal, ecchymotic, warm, or showing signs of compromise
• Tenderness: Present or absent, degree if present
• Associated findings: Pulse deficits, neurological changes, or signs of expansion 1, 3