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A bruise, also known as a contusion, is a type of hematoma of tissue, the most common cause being capillary damaged by Physical trauma, causing localized bleeding that into the surrounding interstitial tissues. Most bruises occur close enough to the epidermis such that the bleeding causes a visible discoloration. The bruise then remains visible until the blood is either absorbed by tissues or cleared by immune system action. Bruises which do not blanch under pressure can involve capillaries at the level of skin, subcutaneous tissue, muscle, or bone.
Bruises are not to be confused with other similar-looking . Such lesions include petechia (less than , resulting from numerous and diverse etiologies such as adverse reactions from medications such as warfarin, straining, asphyxiation, platelet disorders and diseases such as cytomegalovirus); and purpura (), classified as palpable purpura or non-palpable purpura and indicating various pathologic conditions such as thrombocytopenia. Additionally, although many terminology schemas treat an ecchymosis (plural, ecchymoses) (over ) as synonymous with a bruise, in some other schemas, an ecchymosis is differentiated by its remoteness from the source and cause of bleeding, with blood dissecting through tissue planes and settling in an area remote from the site of trauma or even nontraumatic pathology, such as in periorbital ecchymosis ("raccoon eyes"), arising from a basilar skull fracture or from a neuroblastoma.
As a type of hematoma, a bruise is always caused by internal bleeding into the interstitial tissues which does not break through the skin, usually initiated by blunt trauma, which causes damage through physical compression and acceleration forces. Trauma sufficient to cause bruising can occur from a wide variety of situations including accidents, falls, and surgeries. Disease states such as insufficient or malfunctioning , other coagulation deficiencies, or vascular disorders, such as venous blockage associated with severe allergies can lead to the formation of purpura which is not to be confused with trauma-related bruising/contusion. If the trauma is sufficient to break the skin and allow blood to escape the interstitial tissues, the injury is not a bruise but bleeding, a different variety of hemorrhage. Such injuries may be accompanied by bruising elsewhere. Kumar, Vinay; Abbas, Abul K.; Fausto, Nelson; & Mitchell, Richard N. (2007). Robbins Basic Pathology (8th ed.). Saunders Elsevier. p. 86
Hematomas can be subdivided by size. By definition, ecchymoses are 1 centimetres in size or larger, and are therefore larger than (less than 3 millimetres in diameter) (2017). 9780323353175 ISBN 9780323353175 or purpura (3 to 10 millimetres in diameter). Ecchymoses also have a more diffuse border than other purpura. A broader definition of ecchymosis is the escape of blood into the tissues from ruptured blood vessels.Merriam-Webster Dictionary. http://www.merriam-webster.com/dictionary/ecchymosis; accessed 1/2/2012Gould, George M. The Practitioner's Medical Dictionary, P. Blakiston's Son & Co., 1916 et seq.; p. 311 The term also applies to the subcutaneous discoloration resulting from seepage of blood within the injured tissue.
Bruise colors vary from red, blue, or almost black, depending on the severity of broken capillaries or blood vessels within the bruise site. Broken or often result in a deep blue or dark red bruise, respectively. Darker colored bruises may result from a more severe bleeding from both blood vessels. Older bruises may appear yellow, green or brown.
The presence of bruises may be seen in patients with platelet or coagulation disorders, or those who are being treated with an anticoagulant. Unexplained bruising may be a warning sign of child abuse, domestic abuse, hard blows during , shot by rubber bullets during protests, hit by falling objects/stuck inside rubble during earthquakes, hit by hailstones/falling volcanic debris caused by volcanic eruptions with alert level IV–V ("warning") and/or serious medical problems such as leukemia or meningococcus infection. Unexplained bruising can also indicate internal bleeding or certain types of cancer. Long-term glucocorticoid therapy can cause easy bruising. Bruising present around the navel (belly button) with severe abdominal pain suggests acute pancreatitis. Connective tissue disorders such as Ehlers–Danlos syndrome may cause relatively easy or spontaneous bruising depending on the severity. Spontaneous bruising or bruising with minimal trauma in the absence of other explanations and together with other minor or major criteria suggestive of vascular Ehlers–Danlos Syndrome (vEDS) suggests genetic testing for the condition.Byers PH. Vascular Ehlers-Danlos Syndrome. 1999 Sep 2 Updated. In: Adam MP, Ardinger HH, Pagon RA, et al., editors. GeneReviews® Internet. Seattle (WA): University of Washington, Seattle; 1993–2020. Available from: https://www.ncbi.nlm.nih.gov/sites/books/NBK1494/
During an autopsy, bruises accompanying abrasions indicate the abrasions occurred while the individual was alive, as opposed to damage incurred post mortem.
| + Bruise harm score | ||
| 0 | Light bruise | No damage |
| 1 | Mild bruise | Little damage |
| 2 | Moderate bruise | Some damage |
| 3 | Serious bruise | Dangerous |
| 4 | Extremely serious bruise | Very dangerous |
| 5 | Critical bruise | Risk of death |
The harm score is determined by the extent and severity of the injuries to the organs and tissues causing the bruising, in turn depending on multiple factors. For example, a contracted muscle will bruise more severely, as will tissues crushed against underlying bone. Capillary vary in strength, stiffness and toughness, which can also vary by age and medical conditions.
Low levels of damaging forces produce small bruises and generally cause the individual to feel minor pain straight away. Repeated impacts worsen bruises, increasing the harm level. Normally, light bruises heal nearly completely within two weeks, although duration is affected by variation in severity and individual healing processes; generally, more severe or deeper bruises take somewhat longer.
Severe bruising (harm score 2–3) may be dangerous or cause serious complications. Further bleeding and excess fluid may accumulate causing a hard, fluctuating lump or swelling hematoma. This has the potential to cause compartment syndrome in which the swelling cuts off blood flow to the tissues. The trauma that induced the bruise may also have caused other severe and potentially fatal harm to internal organs. For example, impacts to the head can cause traumatic brain injury: bleeding, bruising and massive swelling of the brain with the potential to cause concussion, coma and death. Treatment for brain bruising may involve emergency surgery to relieve the pressure on the brain.
Damage that causes bruising can also cause bones to be Bone fracture, or muscles to be strained, to be , or other tissue to be damaged. The symptoms and signs of these injuries may initially appear to be those of simple bruising. Abdominal bruising or severe injuries that cause difficulty in moving a limb or the feeling of liquid under the skin may indicate life-threatening injury and require the attention of a physician.
During this time, larger bruises may change color due to the breakdown of hemoglobin from within escaped red blood cells in the extracellular space. The striking colors of a bruise are caused by the phagocytosis and sequential degradation of hemoglobin to biliverdin to bilirubin to hemosiderin, with hemoglobin itself producing a red-blue color, biliverdin producing a green color, bilirubin producing a yellow color, and hemosiderin producing a golden-brown color. As these products are cleared from the area, the bruise disappears. Often the underlying tissue damage has been repaired long before this process is complete.
Very gently massaging the area and applying heat may encourage blood flow and relieve pain according to the gate control theory of pain, although causing additional pain may indicate the massage is exacerbating the injury. As for most injuries, these techniques should not be applied until at least three days following the initial damage to ensure all internal bleeding has stopped, because although increasing blood flow will allow more healing factors into the area and encourage drainage, if the injury is still bleeding this will allow more blood to seep out of the wound and cause the bruise to become worse.
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