What causes a hematoma in the chest?

According to the National Center for Biotechnology Information, blunt thoracic trauma is a common cause of chest wall injuries, which can lead to a hematoma. Understanding what causes a hematoma in the chest is crucial for proper diagnosis and management, as the severity can range from a minor bruise to a life-threatening complication.

Quick Summary

A chest hematoma is an accumulation of blood outside of blood vessels in the chest area, most commonly caused by blunt force trauma from incidents like car accidents or falls. Other significant factors include complications from surgical procedures, the use of anticoagulant medications, and underlying medical conditions that affect blood clotting.

Key Points

• Trauma is the leading cause: The most frequent cause is blunt force trauma to the chest, such as from a car accident, fall, or sports injury.

• Surgery is a contributing factor: Hematomas can develop as a complication of surgical procedures involving the chest or breast.

• Anticoagulants increase risk: Use of blood-thinning medications is a major risk factor for hematoma formation, even after minor trauma.

• Underlying conditions can be a factor: Bleeding disorders and liver disease can impair the body's clotting ability, leading to spontaneous or easily-triggered hematomas.

• Seek medical evaluation for chest injuries: Any suspected hematoma, especially following significant trauma, warrants medical assessment to rule out more serious complications like internal bleeding.

The Primary Role of Trauma

Blunt force trauma is the leading cause of a hematoma in the chest. This occurs when an external force impacts the chest, damaging blood vessels beneath the skin without necessarily breaking the skin itself. The force can be significant, but even minor trauma can lead to a hematoma, especially in individuals with pre-existing conditions or those on certain medications. The chest wall contains numerous small blood vessels that can rupture and bleed into the surrounding tissues, causing the characteristic swelling and discoloration. A fracture of a rib is a particularly common traumatic cause, as the sharp edge of the broken bone can lacerate nearby blood vessels, leading to significant and potentially delayed bleeding.

Common traumatic events include:

• Motor vehicle accidents: The force of a seatbelt or impact with the steering wheel can cause severe chest trauma.
• Falls: A fall, particularly in older adults, can result in rib fractures and chest wall contusions.
• Sports injuries: Contact sports like football or hockey can involve direct blows to the chest.
• Assaults: Physical altercations involving strikes to the chest can cause internal bleeding.
• Workplace accidents: Injuries from heavy equipment or falling objects are also significant causes.

Surgical and Procedural Complications

A chest hematoma can also be a side effect of medical procedures and surgeries involving the chest. Any surgery where blood vessels are cut and not completely sealed can lead to a pocket of blood forming in the tissue. In addition, the insertion of medical devices can sometimes damage blood vessels. While rare, a hematoma can also develop after a minimally invasive procedure.

Procedures associated with chest hematomas:

• Breast surgery: Hematomas can occur after cosmetic procedures like breast augmentation or reduction, or after cancer-related surgeries like lumpectomy or mastectomy.
• Cardiothoracic surgery: Procedures involving the heart, lungs, or major blood vessels in the chest carry a risk of post-operative bleeding that can lead to a hematoma.
• Pacemaker insertion: The surgical procedure to implant a pacemaker can sometimes result in bleeding and a localized hematoma.
• Central venous catheterization: A procedure to place a catheter in a large vein can sometimes cause an injury to a nearby blood vessel.

Underlying Medical Conditions

Certain health conditions can increase a person's risk of developing a chest hematoma, even with minimal or no trauma. These conditions affect the body's ability to clot blood effectively, leading to increased bleeding from minor vessel damage.

Medical conditions that can lead to hematomas:

• Bleeding disorders: Inherited conditions like hemophilia or von Willebrand disease impair blood clotting, making hematomas more likely.
• Blood cancers: Diseases like leukemia and lymphoma can affect platelet production and function, leading to easy bruising and hematoma formation.
• Liver disease: Since the liver produces many of the body's clotting factors, severe liver disease can cause a bleeding tendency.
• Spontaneous causes: In rare cases, a hematoma may form spontaneously without any apparent cause, possibly due to a previously undiagnosed medical issue or fragile blood vessels.

Risk Factors Increasing Likelihood

Several other factors can predispose an individual to developing a chest hematoma. These often involve medications or age-related changes that affect the blood and blood vessels.

Factors influencing hematoma risk:

• Anticoagulant medications: Individuals on blood thinners like warfarin, heparin, or antiplatelet drugs (e.g., aspirin) are at a higher risk of bleeding and hematoma formation, even from mild trauma.
• Advanced age: With age, blood vessels become more fragile and the skin thins, making older adults more susceptible to hematomas.
• High blood pressure: Chronic hypertension can weaken blood vessel walls, increasing the risk of rupture.

Comparing Hematomas and Bruises

While a bruise (or contusion) is a type of hematoma, a chest wall hematoma can be much more severe. A comparison helps clarify the difference.

Feature	Bruise (Contusion)	Hematoma (Chest)
Cause	Minor trauma, damaged capillaries	Significant trauma, surgery, or underlying condition
Size	Typically small, flat, and spreads out	Can be large, raised, and localized into a mass
Location	Mostly superficial, just under the skin	Can be superficial or deep within muscle tissue
Symptoms	Mild pain, skin discoloration	Significant pain, swelling, pressure, and potential nerve symptoms
Risks	Minimal risk, resolves on its own	Risk of pressure on nerves, infection, or internal bleeding

Diagnosis and Treatment

If a chest hematoma is suspected, particularly after trauma, medical evaluation is critical. A doctor will typically perform a physical exam and may order imaging tests to assess the size and location of the hematoma, and to check for associated injuries like rib fractures or internal bleeding. In some cases, a chest hematoma can be a sign of a more serious internal issue.

Diagnostic tools include:

1. Computed Tomography (CT) Scan: A CT scan is highly effective for identifying chest wall hematomas, especially after trauma, and for ruling out other injuries like a hemothorax (blood in the chest cavity).
2. Ultrasound: This can be used to visualize the collection of blood and determine its characteristics.
3. Angiography: If active bleeding is suspected, an angiogram may be performed to pinpoint the exact location of the bleeding vessel, potentially followed by arterial embolization to stop the bleeding.

Treatment varies depending on the severity. Minor hematomas often resolve on their own over several weeks, similar to a bruise. Larger or more symptomatic hematomas may require medical intervention, such as surgical drainage or angiographic embolization. Ongoing monitoring is important, especially for patients with underlying risk factors or those on anticoagulants.

Outlook and When to Seek Help

Most minor chest hematomas will heal without complication, but it is important to consult a healthcare professional to ensure there are no other underlying issues. For instance, a hematoma appearing after a chest injury should always be evaluated, as it could mask a more serious issue like a rib fracture or a laceration of a major vessel. For those with bleeding disorders or who take blood thinners, any hematoma, regardless of its size, warrants medical attention. The Cleveland Clinic provides excellent general information on the causes and risks associated with hematomas, which can help guide your discussion with a doctor: Cleveland Clinic on Hematoma.

Conclusion

A hematoma in the chest can be caused by a variety of factors, from common blunt force trauma to more complex medical conditions and surgical procedures. The symptoms can range from a simple bruise to significant pain and swelling, and proper diagnosis is key to ensuring appropriate treatment. Understanding the potential causes and risk factors can help you and your healthcare provider determine the best course of action. Always seek professional medical advice if you suspect a significant chest hematoma, especially after an injury or surgery.

Frequently Asked Questions

What is the most common cause of a chest hematoma?

The most common cause is blunt force trauma, such as from a car accident, a fall, or a sports injury. This can damage the blood vessels in the chest wall, leading to a collection of blood.

Can surgery on the chest cause a hematoma?

Yes, surgical procedures on or near the chest, such as breast surgery or pacemaker insertion, can cause a hematoma as a complication if blood vessels are not fully sealed during or after the procedure.

How do blood-thinning medications relate to chest hematomas?

Medications that prevent blood clotting, known as anticoagulants, increase the risk of bleeding and hematoma formation. Individuals taking these medications may develop a chest hematoma more easily after mild trauma.

What are the signs and symptoms of a chest hematoma?

Symptoms can include noticeable swelling, a firm or spongy lump, pain, and discoloration similar to a deep bruise. If the hematoma is large, it can cause significant discomfort and pressure.

How is a chest hematoma diagnosed?

Diagnosis typically involves a physical examination by a doctor. Imaging tests, such as a CT scan or ultrasound, are often used to determine the size, location, and nature of the hematoma and to check for associated injuries.

When should I see a doctor for a chest hematoma?

You should seek medical evaluation if you suspect a chest hematoma after a significant injury or surgery. It's especially important if you experience severe pain, difficulty breathing, or notice the swelling getting larger.

What is the difference between a chest hematoma and a hemothorax?

A hematoma is a localized collection of blood outside of a major cavity, typically within the chest wall tissue. A hemothorax is a more serious condition where blood collects within the pleural cavity, the space between the chest wall and the lung.

Can a hematoma in the chest be a sign of something more serious?

Yes. While many hematomas are benign, they can sometimes indicate a more significant injury, such as internal organ damage or a major blood vessel tear, especially after severe trauma.