What is Muscular Hematoma?
Muscular hematomas are essentially when bleeding occurs inside a muscle group. They can happen because of an injury (traumatic) or suddenly without an obvious cause (spontaneous). While traumatic muscle hematomas can cause pain, they usually can be handled with rest and non-strong pain medication. On the other hand, spontaneous muscle hematomas often occur in the belly area and can potentially become dangerous, life-threatening conditions.
What Causes Muscular Hematoma?
Spontaneous muscle bruising or hematomas are often linked with blood-thinning medications. These usually happen in three specific areas of the body:
The Front of the Belly
The front of the belly includes muscles such as the rectus abdominis (your “abs”), the external oblique (side abs), the internal oblique (under the side abs), and the transverse abdominis (located under the obliques). The blood supply for these muscles comes from the lower stomach arteries and the curved hip arteries.
The Back of the Belly
The back of the belly consists of the iliacus (hip-flexing muscle), the psoas (another hip flexer), and the erector spinae muscles (located along your spine). These muscles get their blood supply from the back part of the hip trunk through the back and hip-bone related arteries.
Buttocks Muscles
The muscles of the buttocks include the gluteus maximus (largest butt muscle), medius (top glute muscle) and minimus (smallest glute muscle), as well as the piriformis (a small muscle located behind the gluteus maximus) and the short external rotators (helps the hip rotate outwards). These muscles are supplied with blood through the internal hip artery via the top and bottom gluteal muscles.
Risk Factors and Frequency for Muscular Hematoma
Muscular hematomas caused by trauma can happen to anyone, regardless of their age or background. However, spontaneous muscle hematomas—those that occur without an injury—are more common in older people who are taking blood thinners. About 5% of these patients may experience a spontaneous muscle hematoma, and the annual death rate associated with this condition is 0.65%.
Signs and Symptoms of Muscular Hematoma
If someone gets hurt badly, they might develop a muscular hematoma, which is a large bruise in the muscle. You might not notice signs of this injury for several days, especially if you have other injuries that are more obvious.
Once in a while, a person might get a muscular hematoma without any obvious injury. This can happen if a person takes medication to thin their blood, which is more common in older people. The hematoma can show up as pain in the side or belly.
Doctors should always look out for signs that the person is losing blood, like a fast heartbeat, low blood pressure, and pale skin color. Too much blood loss can lead to anemia or even organ failure. It’s also important to note that the blood clotting test (INR) will usually stay within the target range. However, doctors should be careful not to give too much blood-thinning medication, because this could lead to problems in up to a third of these kinds of cases.
Testing for Muscular Hematoma
If your doctor thinks you might have a spontaneous muscular hematoma, which is a bleeding within the muscle, they will likely order a special type of scan called a non-enhanced multidetector computed tomography (abbreviated to MDCT). This scan is very useful in helping manage your health, but it may not be able to pinpoint exactly where any active bleeding is happening.
In such cases, the doctor may recommend an imaging test called a CT-angiogram. A CT-angiogram is better at showing the source of the bleeding and whether the bleeding is still taking place. It’s especially effective in the abdomen area and more sensitive than an arteriography, another type of scan. It correctly identifies the condition in about 80% of cases, and is correct about not having the condition in about 67% of cases.
Treatment Options for Muscular Hematoma
If you have a traumatic hematoma, which is a collection of blood outside of blood vessels caused usually by an injury, doctors typically allow it to heal on its own, particularly if you’re not taking any blood-thinning medications. In these cases, the bleeding often stops on its own. However, spontaneous muscular hematomas, which occur without an external cause in the muscles, often continue bleeding. In these situations, a medical imaging test known as a CT-angiogram may be done to better assess the hematoma and pinpoint its origin.
The first course of action when dealing with a hematoma is to stop any blood-thinning medications if it’s safe to do so. This change can often be enough to allow the body to stop the bleeding and the hematoma to resolve. Surgical removal of the hematoma may be necessary in cases where it is pressing on nerves or causing a shortage of blood supply to nearby tissues. It’s important to note that these hematomas often recur, so careful monitoring is crucial to spot any signs of a recurrence.
Sometimes, arterial embolization might be recommended as a treatment option for spontaneous muscular hemorrhages or bleeding. This procedure blocks the blood vessel leading to the hematoma, which helps control the bleeding. It has the advantage of being less invasive than surgery while still being fairly successful, with a success rate ranging from 57 to 69 percent.
What else can Muscular Hematoma be?
When doctors look for the cause of a spontaneous muscular hematoma, or an unexpected blood clot in a muscle, they consider the location of the clot. Here are some key things they look at depending where the clot is located:
- If it’s in the abdominal wall region, the doctors need to include it in all potential causes of pain in either the right or left lower part of the abdomen.
- If the clot is in the lumbar or gluteal regions – which are in the lower back or buttocks – it is important to consider whether the clot is causing pressure and pain on the spinal roots.
- In these same areas, doctors also need to test for other conditions, like a strangulated hernia, twisting of an ovarian cyst, blockage or tear in the intestine, abdominal tumors, or appendicitis.
What to expect with Muscular Hematoma
People with muscle bruises caused by injury generally have good outcomes. However, people with muscle bruises that occur on their own have a mortality rate between 4 to 20%. Moreover, the need for more blood transfusions, a common treatment for such conditions, is associated with higher mortality rates. This aligns with the widely held belief that unstable blood flow is the biggest threat to patient health and survival when dealing with this condition.
Possible Complications When Diagnosed with Muscular Hematoma
Myositis ossificans is a condition that responds to muscle injuries, such as bruising, by producing an excess of connective tissue cells, cartilage, and bone. This condition most often impacts muscles such as the quadriceps (front of the thigh), the brachialis (upper arm), and the gluteal muscles (buttock). The good news is that this condition usually resolves on its own, with the size of the affected area often decreasing after about a year.
Affected Muscles:
- Quadriceps (front of thigh)
- Brachialis (upper arm)
- Gluteal muscles (buttock)
Preventing Muscular Hematoma
If you get a muscle bruise or ‘hematoma’ from an injury, it will usually heal on its own. However, it can be a good idea to see a healthcare professional if this happens. They can check if there are any other injuries you might have missed. Even if your hematoma seems to have come out of the blue, it’s still a good idea to get checked out. Healthcare professionals can help you understand and decide on the best treatment, considering all the factors.
One possible treatment is anticoagulation therapy, which is medication to prevent blood clots. But this should only be stopped under the supervision of a clinician who knows your full medical history because each patient’s situation is different. Decisions about your treatment will be made based on your specific circumstances.
