10 signs when a bruise indicates health problems

What it is

Breast hematoma is an accumulation of blood in the breast tissue. The severity of the disease depends on the size of the hematoma and its location. Pathology code according to ICD-10: S20.0 “Breast contusion.”

This is what a breast hematoma looks like

The size of the hematoma can vary from a few millimeters to a large formation spreading to the entire mammary gland. The collection of blood may be located close to the surface of the skin or under the skin. Also, the hematoma can be localized in the deep layers of the mammary gland.

Externally, a hematoma or bruise is a bright blue, purple or red spot, which over time changes its color to a lighter color, and often disappears.

If the bruise is localized in deeper layers, the breast increases in size, swells, and becomes cyanotic. In most cases, women experience a small hematoma, but extensive accumulation of blood in the thickness of the mammary gland is also possible.

Pathology rarely poses a danger to a woman’s life and health. Often, the body will eliminate the accumulated blood on its own within a few weeks. But it is important to consider the reasons for its occurrence. Often these are injuries and bruises, so it is necessary to exclude the presence of damage to internal organs and bone fractures.

If the hematoma is large in size with a large accumulation of blood, complications may develop in the form of infection of the mammary gland, abscess formation, and necrosis of healthy tissue.

At the site of the hematoma, calcium accumulations or dense connective tissue may remain. This is not dangerous to health, but can cause discomfort and have a cosmetic defect.

Is a bruise a minor health hazard or what?! From the practice of an independent forensic doctor

The citizen kicked the policeman in the knee. The interdistrict forensic medical expert assessed the bruise of the soft tissues of the right knee joint as a slight harm to health. In the indictment: Part 2 of Art. 318 of the Criminal Code of the Russian Federation, the use of violence against a representative of the authorities that is dangerous to life or health. Punishable by imprisonment for a term of up to ten years, suspended sentence is possible in case of imprisonment for a term of only up to eight years - Part 1 of Art. 73 of the Criminal Code of the Russian Federation. During interrogation by the investigator and in the city court, the interdistrict medical examiner confirmed his conclusion. The defense lawyer brought me in as a specialist (Part 2.1 of Article 58 of the Code of Criminal Procedure of the Russian Federation). I saw the forensic perspective of my participation in convincing the court that there was no harm to health. This would entail requalification under Part 1 of Art. 318 of the Criminal Code of the Russian Federation, violence not dangerous to life or health, imprisonment for up to five years. Thus, differential diagnosis (may legal scholars forgive the doctor for medical terminology!) between the indicated parts of the article depended on me. And I did it.

Argument I

I always start by establishing: “what damage has been caused.” Without this, further actions are pointless. The term “bruise” is often used in a wide variety of branches of medicine and has many meanings. We are only interested in the bruise of the external soft tissue integument of the body (soft tissue) in relation to determining the severity of harm to health in a forensic medical examination. There is only one standard where such a bruise is mentioned: Medical criteria for determining the severity of harm caused to human health, approved by order of the Ministry of Health and Social Development of the Russian Federation No. 194n dated April 24, 2008. Medical criterion 9 characterizes a bruise as follows: “Superficial injuries, including :... soft tissue bruise, including bruising and hematoma...” Thus, the analyzed text indicates the mandatory signs of a “forensic” bruise, namely, “bruising and hematoma.” Consequently, I can only call a bruise such a superficial injury in which I find bruising and hematoma. Let us ask how the injury was described by the inter-district medical examiner, who personally examined the victim: “edema and swelling of the soft tissues of the inner surface of the area of ​​the right knee joint in an area of ​​3x3 cm was discovered, palpation of this area and the axial load on the right lower limb was painful.” In this description there is no bruising or hematomas, required for a bruise. In the conclusions, the inter-district medical examiner called what was described a bruise. Without establishing the essence of the detected pathology, it is impossible to determine the degree of severity: “The severity of harm caused to human health is not determined if ... in the process of a medical examination of a living person, studying case materials and medical documents, it is not possible to determine the essence of harm to health” (the said order, clause 27, paragraph 1).

Argument II

The Inter-District Medical Examiner, in violation of the order, concluded that the pathology he described was a bruise and caused minor harm to health. In doing so, he referred to criterion 8.1 of the said order. I’ll quote how he put it: “the bruise... caused slight harm to health, based on a temporary impairment of the functions of organs and (or) systems (temporary disability) lasting up to three weeks from the moment of infliction (up to 21 days inclusive) (short-term health disorder).”

Interdistrict SME, when quoting criterion 8.1, missed the term “temporary disability” (I crossed out these words). He apparently knows that temporary disability is established by the attending physician by issuing a certificate of incapacity for work (Federal Law No. 323-FZ of November 21, 2011 “On the fundamentals of protecting the health of citizens in the Russian Federation”, Article 59 “Examination of temporary disability”). In fact, the victim did not go to the doctor about the “bruise”, was not released from work, and was on police duty for 24 hours the next day after the incident. Thus, temporary disability and short-term health disorder, as obligatory signs of minor harm to health, are absent. And it’s hard to imagine that a skin swelling measuring 3 cm would need medical attention. And it was the reason: “the axial load on the right lower limb is painful” (from the description of the swelling of the interregional SME). This symptom could only appear if there was damage to the bone or knee joint. Consequently, the swelling, even if it is a bruise, did not cause slight harm to health.

Argument III

Even if we assume that the swelling described by the interregional SME is a bruise, then criterion 9 is provided for its assessment, which directly indicates that

“Superficial injuries, including: ... soft tissue contusion, including bruising and hematoma ... that do not entail short-term health problems or a slight permanent loss of general ability to work, are regarded as injuries that do not cause harm to human health” (the said order).

According to this criterion, a bruise does not cause harm to health.

Let's go back to the courtroom. The judge, after my testimony and the inclusion of the expert’s report in the case (see attached documents, , , , , , , and ), overcame the resistance of the prosecutor, who was satisfied with slight harm, and ordered a re-examination in the regional center. The commission of forensic experts supported me. At the proposal of the prosecutor, the organizing expert was questioned in court (Federal Law No. 73-FZ of May 31, 2001 “On State Forensic Expert Activities in the Russian Federation,” Article 21, paragraph 6), who withstood the prosecutor’s onslaught. The prosecutor began to insist on conducting another examination - in another institution. The court refused and reclassified the act under Part 1 of Art. 318 of the Criminal Code of the Russian Federation, 1.5 years probation (conviction).

In the regional court we met: the appeal presentation of the prosecutor, who continued to insist on a re-examination, asked to cancel the verdict and send the case for a new trial in a different composition, and the appeal complaint of the defense lawyer (pages , , , and ), who exposed all the procedural flaws of the investigation and the court, who asked to cancel the verdict and return the criminal case to the prosecutor to remove obstacles to the court's consideration. The appeal left the decision of the city court unchanged.

The story told demonstrates how shaky/unsteady/unstable the line is between: slight harm to health and its absence, part 2 and part 1 of Art. 318 of the Criminal Code of the Russian Federation, between imprisonment for a term of up to ten years and for a term of up to 5 years.

Only the forensic medical line of defense went through a long winding path in the criminal court: the conclusion of an inter-district forensic expert at the preliminary investigation, the testimony of an inter-district forensic expert at the preliminary investigation, the testimony of an inter-district forensic expert in court, the testimony of a specialist, the conclusion of a specialist, the conclusion of a regional commission of experts, the testimony of an expert - organizer in court, the prosecutor's demand in the court of first and second instance to re-appoint a commission examination. The defense attorney had other arguments that “criminal” lawyers will be able to evaluate by reading the attached procedural documents.

Causes and types of hematomas

Hematomas never occur without a reason. Most often they appear after bruises and injuries, but there are other ways of development. The most common reasons for their appearance in the mammary gland are:

• bruises - falls on the chest, sports injuries;
• postoperative hematomas - after surgical treatment, plastic surgery or cosmetic procedures;
• after puncture of a cyst or biopsy of breast tissue;
• after surgery on nearby organs - heart, lungs;
• treatment with drugs that reduce blood clotting.

Rarely, a breast hematoma occurs for no apparent reason. That is, there were no injuries, operations or other factors in its development. Such hematomas occur against the background of a blood clotting disorder. The cause of this may be coagulopathies, thrombocytopenia, hematological, autoimmune diseases, liver or kidney pathologies.

Depending on the type of injury and the location of the hematoma, the following types of chest bruises are distinguished:

• premammary - on the surface of the skin;
• intramammary - injury to fatty tissue. Accompanied by swelling and discoloration of the skin in a bright purple color;
• retromammary - the bruise is localized behind the mammary gland in the cellular space. An internal hematoma develops.

Retromammary contusion leads to a large accumulation of blood. In case of severe injuries, all parts of the mammary gland can be injured.

Non-medicinal:

• • immediately after a bruise (injury), apply something cold to the affected area (ideally ice);
• • internal hematomas of the upper and lower extremities require the application of a tight bandage;
• • 1-2 days after the appearance of a hematoma, you can use heat compresses (vodka, vinegar), which promote rapid resorption of the formation;
• • physiotherapy, which is prescribed by a specialist.

For intracerebral hematoma, only medical and surgical treatment is carried out, which consists of evacuating accumulated blood by puncture or completely opening the skull.

In case of infection of the hematoma, the lesion is opened, the cavity is cleaned, and it is washed with an antiseptic. The wound is then drained and a tight bandage is applied. If the autopsy was performed to remove accumulated blood (clots), then sutures are applied, which are removed after 10 days. If the operation was performed for a suppurative hematoma, then no stitches are applied; regular washing of the wound with antibiotics will be required to prevent the spread of infection.

Symptoms

The main complaint of women is the presence of a hematoma and chest pain. It is a consequence of trauma to the breast and intensifies with pressure on the mammary gland. If the hematoma occurs against the background of coagulopathy, there is no pain.

Also, against the background of pathology, the following complaints arise:

• swelling and enlargement of the breast;
• detection of a bruise on the skin;
• fluctuation - with a slight push to the chest, a wave-like movement of fluid in the mammary gland is felt.

At the site of the hematoma, the skin is hot to the touch and painful. If the blood has coagulated, a lump is felt upon palpation.

Features of spinal bruise

Such an injury is considered quite serious, since nerve endings, ligaments and bones can be affected. Damage to the spine has its own characteristics:

1. Causes . A spinal bruise can occur as a result of falling on your back or a road accident. This type of injury often occurs during sports training. In older people, problems with the spine can arise even as a result of a slight bruise, since they are already diagnosed with degenerative changes in the spine.
2. Symptoms . Signs of injury and contusion include pain, limitation of movement, swelling and hematoma. In case of damage to nerve fibers, numbness and tingling of the limbs may be diagnosed. Serious injury can cause disruption of the gastrointestinal tract and even complete paralysis.
3. Diagnostics . The victim is given an X-ray and, if necessary, a magnetic resonance imaging or computed tomography scan is performed. This type of injury often requires examination of the vessels with a contrast agent, so angiography is performed.
4. First aid . In the event of a spinal injury, it is very important that the victim is at rest. This should also be taken into account when transporting it to a medical facility. It is necessary to ensure that the bruised spine does not bend.
5. Treatment . The nature, location and severity of the injury influence treatment tactics. If necessary, the attending physician prescribes wearing a special corrective corset. In some cases, surgery is used to decompress the spinal cord and restore normal blood supply. It is important to know what not to do with such bruises. The victim should avoid heavy physical labor and gradually introduce physical activity.
6. Consequences . Very often, after such an injury, instability develops in the damaged area of ​​the spine. The patient may suffer from pain and symptoms of chronic inflammation. Pathological curvatures of the spine may appear, which significantly worsen a person’s quality of life.

Victims with a spinal bruise should be hospitalized. Reducing the negative consequences of injury and speeding up rehabilitation is only possible with timely treatment.

Diagnostics

A mammologist diagnoses the disease. If the cause of the disease is injury, examination by a traumatologist is necessary. For coagulopathy, it is recommended to visit a hematologist. The mammologist will examine the breast and palpate it, ask in detail about whether there was an injury, how it was received and other details of the medical history.

Additionally, the doctor will prescribe the following research methods:

• Ultrasound of the breast;
• mammography;
• puncture of the contents of the hematoma;
• general blood analysis;
• coagulogram.

Old hematomas, in place of which a scar or calcification has formed, are very similar to breast cancer on mammography ultrasound. To differentiate the diagnosis, it is necessary to do a biopsy of the formation for histological examination.

If an infection is suspected, a puncture is performed for bacteriological examination of the contents of the hematoma.

Help for bruises

After a bruise, the victim usually needs first aid, the amount of which depends on the degree of damage.

Consequences of bruises such as abrasions or external bleeding require treatment with an antiseptic and the application of a sterile bandage. Detachment of the skin, characteristic of multiple injuries and damage to internal organs, requires the victim to be taken to the hospital in an immobilized state; treatment of the bruise is carried out on an outpatient basis. In case of severe injury, breathing or heart rate may stop, which requires immediate resuscitation - artificial respiration and cardiac massage. Sometimes the consequences of bruises are not immediately noticeable: the victim, as a rule, experiences pain and is not always able to adequately assess his condition. But if there is a suspicion of damage to internal organs, the victim must be immobilized and taken by hand or on a stretcher to the nearest emergency room.

If the situation does not require urgent hospitalization, treatment of a bruise can be reduced to the following manipulations:

• Local application of cold. Applying an ice pack, a cold pack, or simply running a stream of cold water will help reduce pain and stop minor bleeding. Cold as a relief for bruises is effective only during the first hours.
• Pressure bandage. It is applied at the site of the bruise immediately after the injury.
• Peace. The best help for a bruise. If an arm is injured, you can fix it with a scarf, and the injured leg is fixed in an elevated position.
• Thermal procedures. Further treatment of the bruise is carried out with the help of heating pads, warm baths, warm compresses - this promotes the resorption of hematomas.
• Restorative procedures. To treat a bruise on an outpatient basis, as a rule, therapeutic exercises, physiotherapy, electrophoresis, and massage are prescribed.

Treatment

Treatment of a hematoma depends on its size and the amount of blood accumulation in the tissues. Minor bruises go away on their own. If there is a large accumulation of blood in the chest, your doctor may prescribe the following medications :

:

• heparin ointment or troxevasin externally to accelerate the resorption of the hematoma;
• NSAIDs for pain relief;
• diuretics - will relieve swelling;
• Antibiotics—prevention of bacterial infection.

In most cases, treatment can be done at home. The doctor will prescribe local treatment and, if necessary, tablets that dissolve blood clots and blood clots. Serious injuries require hospital treatment in traumatology.

Immediately after receiving a bruise and the formation of a hematoma, it is important to provide the woman with first aid before the ambulance arrives:

• apply a compression bandage to the chest to immobilize it;
• make sure there are no open injuries or bleeding;
• provide the victim with peace in a comfortable body position;
• apply cold to the bruised tissues.

These actions will help reduce swelling and stop bleeding - the hematoma will be much smaller. Physiotherapy may include the use of dry heat.

Extensive hematomas often require surgical treatment. Depending on the severity of the condition, a puncture may be performed to remove accumulated blood, or a partial resection of the mammary gland may be performed to remove damaged tissue.

If the cause of the hematoma is not related to a bruise, but to a blood clotting disorder, additional treatment is provided by a hematologist. Depending on the cause of the condition, he will prescribe medications to improve blood properties.

In folk medicine, compresses are made from decoctions of medicinal herbs or cabbage leaves to resolve bruises. Treatment with folk remedies is possible only after consultation with a doctor, since many of them can be harmful to health.

Complications and consequences

Hematomas that are not treated can lead to the development of complications:

• • hematomas under the eye - to retinal detachment;
• • internal hematomas - replacement of muscle tissue with fibrous tissue;
• • all types of hematomas - suppuration and spread of infection to nearby tissues.

With a cerebral hematoma, there is a risk of developing the following conditions:

• • impairment of motor activity;
• • complete loss of speech;
• • paralysis of limbs;
• • lethargy;
• • coma.

In the most severe cases, death occurs.

What are the dangers of hematomas that regularly appear on the body, regardless of bruises and blows? This phenomenon signals the development of serious diseases - for example, atherosclerosis or hemophilia.

Why is a hematoma dangerous?

With extensive hemorrhages in the cavities of internal organs, after some time the spilled blood begins to decompose with the breakdown of hemoglobin. Endotoxicosis occurs - accumulation and poisoning of tissues by decay products.

A large hematoma on the leg, for example, can lead to the following complications:

• chronic synovitis - inflammation of the synovial membrane of the joint, effusion begins to accumulate in the joint cavity;
• hemarthrosis is bleeding inside a joint.

And intracranial hemorrhages cause mental changes: amnesia, impaired reaction and attention, increased anxiety, seizures, personality changes.

Heavy menstruation

If bruises appear frequently on the body, blood does not clot well when cut, or heavy menstruation is observed, this may indicate the development of von Willebrand disease. This is a genetic disorder. A sick person lacks or weakens von Willebrand factor, a protein responsible for blood clotting. Without it, blood clots worse, which is why bruises and heavy hemorrhages often appear on menstruation days.

Classification

Large hematomas are classified according to several factors. Depending on the location of their formation, there can be subcutaneous, subfascial, submucosal, and intermuscular hematomas. Some specific hemorrhages are detected in the internal organs, in the cranial cavity.

Based on the connection with the vessels, there are pulsating and non-pulsating hematomas. The blood in them can be liquid (fresh), coagulated, or infected and suppurating.

According to clinical signs, diffuse, encysted and limited hematomas are distinguished.

Separately, intracranial hemorrhages (subdural and epidural), intraventricular, intracerebral, subarchial and retrochorial formations are distinguished.

How to remove a hematoma

For the most part, minor bruises resulting from surgery will go away on their own. To speed up the process, ice is applied to the sore spot.

When a hematoma appears on the leg, a pressure bandage is used. Here, bruises often occur if a phlebectomy or removal of veins damaged by varicose veins was performed.

Small subcutaneous bruises are treated with simple folk methods. In particular, compresses are used:

• from vodka pure or with the addition of vinegar;
• saline solution;
• mustard mixed with radish juice.

Drug therapy involves the use of drugs:

• stopping bleeding;
• antibacterial (for prophylactic purposes).

Any ointment containing non-steroidal components will also work. External treatment allows:

• relieve swelling;
• reduce tissue reactivity;
• alleviate pain syndrome.

It is also advisable to prescribe physical therapy to such patients. They must wear compression garments.

Sometimes puncture helps remove the hematoma. In this case, a needle is inserted into the localization site and thus the accumulated liquid is removed.

In severe situations, when conservative methods do not bear fruit, an operation is performed during which the hematoma itself is removed, and the vessel that has not closed is also cauterized. Upon completion, drainage must be installed for at least 3 days.

Significant swelling

If you notice that the bruise is very painful and there is severe tissue swelling, you will need to be examined by a traumatologist. These signs are typical of heavy subcutaneous bleeding. This is especially common when a fall occurs or when a bruise is preceded by another injury.

A slight swelling near the bruise at first is not a cause for concern, but severe swelling and pain that lasts for hours is a good reason to see a doctor. Internal hemorrhage is dangerous to health and life.

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Causes

A hematoma after an impact appears due to rupture of blood vessels. The stronger the bruise, the more extensive the formation in the soft tissues will be. Also, a hematoma can be caused by pinching, squeezing, ruptures and other mechanical effects on the tissue.

If the blow was minor, the hematoma will be small. It can resolve on its own. However, when a serious injury occurs, many small and large blood vessels are torn. In this case, the cavity filled with blood will be extensive. She will not be able to resolve on her own.

However, hemorrhage can occur not only due to injury. For example, it could be a crack in the esophagus or stomach. Violation of vascular permeability can also lead to the appearance of hematomas. Their walls become very fragile. Blood clotting may also be impaired. In this case, there is a high probability of suppuration and infection of the hematoma.

Gets larger over time

A “normal” bruise goes through several stages. Sometimes it does become a little larger than it was at the beginning, and this is normal, especially after a serious bruise. But if it continues to grow and does not decrease after two days, it is a hematoma - an abundant accumulation of blood next to the damaged vessel. Some pass without a trace, others are dangerous.

A hematoma differs from a bruise in that it produces more intense hemorrhage, which in some cases leads to a decrease in blood pressure and shock. In particularly severe cases, it causes organ dysfunction and may require surgery to maintain health.

Brain hematoma

A hematoma is a dangerous formation in some cases. If it appears in the brain, the outcome can be fatal. In this area there is a subdural, epidural and intracerebral hematoma.

In the first case, bleeding occurs due to a venous rupture. An area of ​​blood accumulation forms between the two membranes of the brain (soft and hard). In this case, a gradual fading of consciousness occurs.

An epidural hematoma occurs when blood accumulates between the skull and the dura mater of the brain. It compresses the tissue. This condition requires emergency treatment. The patient may remain conscious or fall into a coma.

An intracerebral hematoma is formed when the brain tissue is gradually filled with blood. This process damages its white matter. Nerve connections are severed. All vital processes of the body are disrupted.

ethnoscience

A hematoma is a formation of varying severity. If it is mild in severity, it can be treated with folk remedies. One effective way is a vodka compress. It is used at night. After the first day has passed after the injury, you need to pour vodka onto the gauze. It is applied to the damaged area and wrapped in plastic wrap. Wrap the compress with a warm cloth on top.

Saline dressings are also used. For 100 ml of water you need to add 2 tablespoons of salt. The compress is secured with an elastic bandage.

Apply lotions from radish juice. Mustard powder is added to it. The resulting pulp is applied to the hematoma. After a slight burning sensation appears, keep the product on the skin for 10 minutes. The procedure is performed daily.

Having considered the features and consequences of a hematoma, one can understand the importance of its timely and complete treatment.