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| Dr. Joel Aronowitz |
Dr. Joel Aronowitz: “Let's talk hematoma. Hematoma means a mass that's heme, that's blood, and hematoma are simply a gelatinous collection of blood that occurs outside of a blood vessel. Inside a blood vessel, it's called a thrombus. So, when the blood spills outside of the vascular system and pools somewhere under the skin or can be inside the brain.
Can be other places that are very dangerous, it's called a hematoma. So hematoma from getting bumped on the forehead is called a cephalohematoma, and it's outside the skull. It's not really dangerous, but a hematoma that's inside the skull, that's under the dura, is called a subdural hematoma, and that can be deadly because it's compressing the brain.
So, when we look at that hematoma, it's actually a big dark red gelatinous mass that has the consistency of blackcurrant jelly, and what it consists of is red blood cells and platelets that are all kind of glued together by the proteins in the bloodstream that coagulate and stick everything together, and that's really vibrant.
So that gets activated by an injury either outside the blood vessel and or inside the blood vessel and or a combination of both probably in most cases. So that hematoma forms once the blood quits spilling from the blood vessel when say platelet plug, and the spasms of the blood vessel are able to control the spillage of blood outside the blood vessel, that hematoma is stable in size, but then what happens to it? What happens to it if it's left in place, and nobody removes it, and it just follows the natural course?
It will organize, and that means that the platelets and the red blood cells will break down, and it will become more fibrous. So, the fibrocytes will sort of invade the blood cells, and the platelets break down, and the contractile elements in that clot will gradually squeeze it more and more, and it'll turn from a rubbery dark red type of mass to more grayish and really has the consistency if you'll forgive me the reference, but it looks just like sort of that wet dog food look, and when you see that inside a cavity that you explore for whatever reason, that's old blood that's an organized hematoma basically.
A small hematoma may never get to that stage; the body may lice it before it can get to that stage. It turns liquid, and then the hemoglobin left over from the red blood cells gets recycled, and the other proteins get taken apart and phagocytosed, and they're taken away, and the whole thing resolves, but if the hematoma doesn't resolve spontaneously like that, it becomes organized. A capsule will frequently form around it made of scar tissue, and it will form a cavity that exists for the rest of the patient's life even, and we'll see some cases where we have a seroma cavity that's lined by fibrous tissue and sometimes a cavity that has blood in it that's a hematoma cavity that's lined by dense scar tissue.
So, hope you enjoyed that explanation that makes it a little bit more clear as you watch examples of hematomas and seromas here in Aronowitzland. More later.”
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