How to tell if a hematoma is getting worse?

September 30, 2025 •

4 min read

While most superficial bruises fade within a couple of weeks, hematomas are more significant blood collections that can take longer to resolve. Understanding how to tell if a hematoma is getting worse is critical to distinguishing between a normal healing process and a potentially serious complication that requires immediate medical attention.

Quick Summary

A worsening hematoma presents with signs different from normal healing, including increasing pain, expanding size, warmth, and redness. Internal hematomas can cause severe symptoms depending on their location, such as intense headache, confusion, or breathing difficulties. Recognizing these escalating symptoms is crucial for knowing when to seek professional medical intervention.

Key Points

Monitor for changes: Watch for increasing pain, swelling, warmth, or size of the hematoma, which indicates worsening rather than normal healing.
Look for signs of infection: A fever (100.4°F or higher), pus drainage, or red streaks around the injury are urgent warning signs.
Be vigilant with head injuries: Any hematoma following head trauma, even if minor, requires immediate medical attention if accompanied by symptoms like severe headache, confusion, or vomiting.
Check for circulation issues in limbs: Hematomas on arms or legs that cause numbness, tingling, or discoloration of hands and feet may signal a dangerous compression of nerves or vessels.
Recognize serious internal symptoms: Severe, unexplained abdominal or chest pain, breathing difficulties, or signs of shock (pale, clammy skin) can indicate a worsening internal hematoma.
Know when it's an emergency: Any neurological symptoms, severe internal pain, or rapid expansion of a hematoma are reasons to seek immediate emergency care.

A hematoma is a localized collection of blood outside the blood vessels, typically caused by trauma or injury. Unlike a minor bruise, which involves only small, broken capillaries, a hematoma is the result of bleeding from a larger blood vessel, leading to a more pronounced, raised area of pooled blood. Most superficial hematomas are not cause for alarm and will resolve naturally over time. However, it is vital to know the indicators that suggest a hematoma is not healing properly and could be getting worse.

Signs of a Normal Hematoma vs. a Worsening One

During the healing process, a hematoma typically goes through predictable changes. Being aware of this normal progression helps in spotting deviations that may signal a problem.

Signs of Normal Healing

Color changes: A hematoma will start as a purplish-blue and gradually fade to green, then brown, and finally yellow as the body breaks down and reabsorbs the blood.
Flattening: The initial raised lump will slowly become flatter and less prominent as the fluid dissipates.
Decreasing pain: The tenderness and discomfort in the area should steadily improve with time.

Signs of a Worsening Condition

Increasing size: The area of swelling or discoloration grows larger over time instead of shrinking.
Intensifying pain: Pain that worsens significantly rather than subsiding is a major red flag.
Increased redness and warmth: While some warmth is normal, a noticeable increase in redness or a feeling of heat radiating from the site can indicate infection.
Developing fever: The presence of a fever of 100.4°F or higher is a key indicator of potential infection.
Pus or red streaking: Pus draining from the injury site or red streaks radiating from the hematoma are clear signs of a serious infection.

Location-Specific Warning Signs

The severity and symptoms of a worsening hematoma are highly dependent on its location. The confined space inside the skull, for example, makes a small bleed much more dangerous than a larger one on a limb.

Head (Intracranial Hematoma)

After a head injury, be alert for these severe and escalating symptoms that may indicate a subdural or epidural hematoma is worsening:

A sudden, severe headache that does not improve.
Confusion, dizziness, or changes in mental status.
Nausea and vomiting.
Slurred speech or difficulty speaking.
One-sided weakness or paralysis.
Loss of balance or trouble coordinating muscle movements.
Seizures or loss of consciousness.
Unequal pupil sizes.

Limbs (Arms or Legs)

For a hematoma on an arm or leg, increasing pressure can threaten blood flow and nerves. Watch for:

Increased swelling and pain in the extremity.
Numbness or a tingling sensation.
A bluish discoloration of the hands or feet, indicating compromised circulation.
The feeling of tightness or extreme pressure, which could signal compartment syndrome, a medical emergency.

Internal Organs (Abdomen/Chest)

Internal bleeding can also form hematomas in areas like the spleen or liver. A worsening condition might present as:

Severe chest or abdominal pain.
Trouble breathing or changes in breathing patterns.
Skin that becomes pale, cold, or clammy.
Feeling faint, lightheaded, or signs of shock.

Beneath a Nail (Subungual Hematoma)

While typically less dangerous, a subungual hematoma under a fingernail or toenail can worsen if the pressure becomes excessive:

Intense, throbbing pain that continues to build.
Swelling and extreme tenderness when pressure is applied to the nail.

Complications of a Worsening Hematoma

If left untreated, a hematoma that continues to expand or becomes infected can lead to serious complications. These include:

Infection and Abscess: Bacteria can colonize the pooled blood, leading to an abscess that requires drainage and antibiotics.
Nerve and Tissue Damage: Growing pressure can compress nearby nerves and blood vessels, resulting in long-term nerve dysfunction or impaired blood flow.
Compartment Syndrome: This life-threatening condition occurs when internal pressure in a muscle compartment swells to a level that cuts off the blood supply.
Chronic Hematoma or Fibrosis: Unresolved blood can organize into a hard, fibrotic mass or scar tissue that can cause chronic pain or stiffness.

Comparison: Hematoma vs. Normal Bruise


Feature	Normal Bruise (Contusion)	Hematoma (Worsening)
Appearance	Flat, discolored skin area. May have slight swelling initially.	Raised, lumpy, or firm mass beneath the skin. Size increases over time.
Feeling	Mildly tender to the touch. Pain improves quickly.	Intense or increasing pain and tenderness.
Healing Time	Resolves within 2 weeks, with predictable color changes.	Takes longer than 2 weeks to heal or gets worse.
Medical Attention	Usually not required. Self-care with RICE method is sufficient.	Immediate medical evaluation needed for worsening symptoms.
Potential Dangers	Rarely causes serious complications unless an additional injury is present.	Can cause severe infection, nerve damage, or put dangerous pressure on organs.

When to Seek Medical Attention

While many hematomas are managed at home, certain signs necessitate prompt medical evaluation. You should contact a healthcare provider if:

Your hematoma rapidly increases in size.
Pain, swelling, or warmth intensifies over several days.
You develop a fever above 100.4°F.
You notice pus or red streaks emanating from the area.
The hematoma is on your head, abdomen, or near a joint, especially if it affects movement or function.

For head injuries or symptoms of intracranial pressure, seek emergency care immediately. Patients on blood thinners are also at higher risk and should be evaluated by a doctor for any new or expanding hematoma.

Conclusion

Most hematomas, like common bruises, are harmless and resolve on their own with proper home care. However, recognizing the critical differences between normal healing and a worsening condition is essential for preventing serious complications. By monitoring for signs such as increasing pain, swelling, and fever, or any specific symptoms related to the hematoma's location, you can ensure timely medical intervention when it's needed most. Staying vigilant and informed is the best way to safeguard your health and recovery.

For more detailed information on wound care and self-monitoring, consider consulting resources like the Cleveland Clinic's health library.

Frequently Asked Questions

A bruise (contusion) results from damage to small capillaries and is typically a flat, discolored area. A hematoma is a more significant collection of blood from a larger blood vessel, forming a raised, often firmer lump under the skin.

A healing hematoma should gradually become softer and less tender over time. The lump will flatten, and the discoloration will change from purplish-blue to shades of green and yellow.

Signs of a hematoma infection include an increase in pain, warmth, or swelling around the lump. You might also develop a fever (100.4°F or higher), see pus draining from the area, or notice red streaks spreading outward.

The duration of a hematoma depends on its size and location. Superficial ones may take several weeks to resolve, while deeper ones can take several months. Most small hematomas will clear up on their own.

You should see a doctor if the hematoma grows rapidly, pain intensifies, or if you experience fever, numbness, restricted movement, or symptoms of an intracranial hematoma after a head injury.

You should not massage a hematoma, especially in the early stages, as this can increase bleeding and worsen the condition. Consult a healthcare provider before attempting any massage, which may only be recommended much later in the healing process.

Compartment syndrome is a dangerous condition that can result from a worsening hematoma, especially in the limbs. The swelling creates excessive pressure within a muscle compartment, which can cut off blood supply to nerves and muscles and cause permanent damage.