Equis ISSN 2398-2977

Hematoma

Contributor(s): Vetstream Ltd

Introduction

  • Cause: trauma - accidental, foaling trauma, physiologic (follicular hemorrhage) or surgical   →   subserosal, subcutaneous or intramuscular hemorrhage   →   accumulation of blood, serum or tissue exudate.
  • Signs: swelling; firm   →   fluctuant; localized pain and heat. Delayed surgical wound healing.
  • Diagnosis: physical examination, needle aspiration, ultrasonography, rectal palpation, response to therapy.
  • Treatment: none   →   cold treatments, local and systemic non-steroidal anti-inflammatory drugs, drainage, pressure bandaging, physiotherapy.
  • Prognosis: good; incisional wounds may have delayed healing.
  • See also:
  • Wound: contusions .
  • Ethmoid hematoma   Ethmoid: hematoma  .
  • Ovary: hematoma .
  • Penis: trauma   Penis: trauma  .
  • Scrotum: trauma   Scrotum: trauma  .
  • Foot: sole bruising   Foot: sole bruising  .

Pathogenesis

Etiology

  • Ovulation   →   excessive follicular hemorrhage.

Predisposing factors

General
  • Horses loose in paddock.

Pathophysiology

General
  • Trauma   →   rupture of micro- and macrovasculature   →   local hemorrhage and inflammation   →   accumulation of fluids   →   localized swelling, pain and heat.
  • Continued hemorrhage   →   swelling enlarges gradually   →   inflammatory response and organization of fluid   →   cessation of hemorrhage   →   swelling firms   →   gradual reduction in size and associated clinical signs.
  • Open wound associated with swelling   →   possible infection   →   abscessation.

  • Surgery
  • Surgical wounds are more likely to develop hematoma or seroma where the following factors are present:
  • Hemorrhage.
  • Tissue trauma.
  • Creation of dead space.
  • Excessive movement at wound site.
  • Hemoglobin   →   inhibits local tissue defences.
  • Iron   →   substrate for bacterial replication and virulence.

  • Ovarian hematoma
  • Ovulation   →   hemorrhage into follicular cavity > normal   →   enlarged ovary:
  • Uneventful resolution.
  • Occasionally destruction of germinal tissue   →   permanent unilateral loss of ovarian function.

Timecourse

  • Acute trauma   →   swelling develops within hours.
  • Continued hemorrhage   →   swelling enlarges over several days.
  • Resolution usually:
  • Hematomas <10 cm diameter, 7-14 days.
  • Hematomas >10 cm diameter, 14-28 days.

Some limb hematomas never fully resolve but persist as a fluid filled swelling, eg false thoroughpin

Diagnosis

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Treatment

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Prevention

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Outcomes

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Further Reading

Publications

Refereed papers

  • Recent references from PubMed and VetMedResource.
  • Sedrish S et al (1998) Theriogenology question of the month. Conservative medical management using cold-water hydrotherapy. JAVMA 212 (2), 197-198 PubMed.
  • Ragle C A et al (1998) Injury to abdominal wall vessels during laparoscopy in three horses. JAVMA 212 (1), 87-89 PubMed.
  • Sedrish S et al (1997) Theriogenology question of the month. Excessive hemorrhaging from ovarian hematomas on both ovaries. JAVMA 210 (2) 179-180 PubMed.
  • Van Hoogmoed L et al (1996) Acute small intestinal injury associated with hematomas in the mesentery of four horses. JAVMA 209 (8) 1453-1456 PubMed.
  • Hyland J et al (1995) The use of ultrasonography in the diagnosis and treatment of a haematoma in the corpus cavernosum penis of a stallion. Aust Vet J 72 (12), 468-469 PubMed.
  • Maxson A D et al (1993) Use of a bovine hemoglobin preparation in the treatment of cyclic ovarian hemorrhage in a miniature horse. JAVMA 203 (9), 1308-1311 PubMed.
  • Dyke T M et al (1988) Ruptured splenic haematoma in a mare. Equine Vet J 192 (3), 379-380 PubMed.
  • Kobluk C N et al (1988) Intramural hematoma in the jejunum of a mare. JAVMA 192 (3), 379-380 PubMed.
  • Memon M A et al (1987) Preputial hematoma in a stallion. JAVMA 191 (5), 563-364 PubMed.
  • Spier S et al (1986) Splenic hematoma and abscess as a cause of chronic weight loss in a horse. JAVMA 189 (5), 557-559 PubMed.
  • Pearson H et al (1986) Submucosal haematoma as a cause of obstruction of the small colon in the horse - a review of four cases. Equine Vet J 18 (4), 340-341 PubMed.
  • Brown C M et al (1981) Gastric hematoma in a horse. Mod Vet Pract 62 (8), 617-618 PubMed.


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