Can Bruises Cause Serious Blood Clots?

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This survival-medicine website provides general information, not individual advice. Most scenarios assume the victim cannot get expert medical help. Please see the disclaimer.

Can a Bruise Cause a Serious Blood Clot?

Bruised legby James Hubbard, M.D., M.P.H.

I see this fairly often. Someone comes in with a whopper of a bruise, maybe with a lump, and they’re afraid it’s a blood clot. In a disaster situation, you’re likely to get some bruises, but you won’t be able to come see me. Should you worry?

In short, probably not. You do have clotted blood, but there are blood clots and there “blood clots.” In fact, if your blood doesn’t clot, you could bleed to death.

Bruise-related clotting happens in tissue outside the blood vessels. That’s where the bleeding occurred. What you’re really worried about is a deep-vein thrombosis (DVT)—a clot that forms inside a deep-in-the-tissue vein and can break off and travel to the lungs. DVTs are different, serious, and sometimes lethal.

So a bruise isn’t a serious blood clot. However, can a bruise cause a serious blood clot? No, but the hit that caused the bruise can—though that’s rare.

If the trauma that caused the bruise injures a large and deep-seated vein’s wall, it could make conditions right for a deep-vein clot to form. These veins are deep in the tissue and have to be hit just right. Compared with the number of bad bruises people get, this is rare as hen’s teeth and has to do with the injury to the vein’s inner wall. The bruise to the soft tissue is incidental.


How Can You Tell Whether You Have a DVT?

Even doctors can have a tough time telling whether you have a DVT. Sometimes one forms with very few outside signs. But suspect it if your arm or leg swells and becomes painful—trauma or no trauma.

Since DVTs often form in the calves, one test is the Homans’ sign. Simplified: You lie down, toes up. The doctor takes hold of your relaxed foot’s sole and quickly flexes your foot, pushing your forefoot back. Significant pain in the calf points toward a deep-venous blood clot. But positive Homans’ sign or not, If the doctor is suspicious, he or she will order a special type of ultrasound test that looks inside the veins to find out for sure. If you have DVT, you’ll be started on a blood thinner.

If you can’t get medical help, your best bet for a swollen, red extremity is to keep it immobile, elevate it at heart level or above, and apply a moderate amount of heat to the area. Get to a doctor as soon as you can.


So What If You Have a Bad Bruise That’s Bothering You?

For a bad bruise, treat it with RICE. That’s

  • Rest
  • Ice. Use a commercial type, a frozen bag of vegetables, or ice in a zip-close bag. Put a cloth between the ice and skin. Use it for something like ten minutes on, ten minutes off, repeat.
  • Compression with an elastic bandage—firm, but not to tight. Loosen as needed.
  • Elevation at heart level or above.

Unlike with DVT, using the extremity poses no threat if you just have a bruise.


What If Only the Bruise Is Swollen?

Sometimes, the area bleeds enough for blood to pool in the soft tissue. If this happens, a localized area will be swollen, even baggy. This is called a hematoma. Other than the RICE, leave it alone. It may even shrink to a smaller, firm spot—a blood clot. But it’s outside the blood vessels. To try to drain it outside of a medical facility is to risk infection.

Don’t be surprised if a large area of discoloration shows up days later. It may even travel with gravity down to areas not bruised. That’s a good thing. The blood from the hematoma is spreading out and will be absorbed.


Bottom Line?

Bruise or no bruise, if your extremity swells or hurts, see a health-care professional. You never know. But don’t get too concerned with some marble-sized knot after a fall.

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Photo by Matt Gibson.

  • Krissy T

    I went kayaking the day before yesterday, Sunday and it is now Tuesday, and I fell into the water onto some rocks. I knew I would have a bruise instantly as it hurt very much. I continued to kayak the rest of the day and had a small bruise. I woke up the next morning, yesterday, to as bruise about the size of half my palm in my hip area. I did some stretching that day, due to all the exercise and rolled over the bruise a few times while changing stretching position on the floor. I was thinking it is good to rub a bruised area to help the blood absorb, hindsight I shouldn’t have done that. I went to work and started to move around more and found pain radiate down my leg (maybe from (swelling?) and off and on pain radiating toward/ near my kidneys and ovarian areas ( again swelling?). At the end of my shift the bruise was twice the size, aching without touch and looked full of blood under the skin. This is also where my apron strings cross so I was adjusting the apron constantly to avoid agitating the bruise. I got home, took an NSAID and iced off and on 15 min. for 2 hours. When I woke up this morning I have pain that now radiates down to my calf the bruise looks the same ( not dissipating) and I feel a deep aching in my inner hip/ on the left (same side as the bruise) almost where my greater trochanter meets? but deep. ( I am certified in massage and know some anatomy) I still have a slight tingling in my left leg- earlier it felt like my leg was falling asleep just sitting on the couch and now it feels more like just my foot and into the bottom of my heal. My upper quad and calf feel achy and I have resisted the urge to massage them as I wouldn’t want to dislodge a clot if there is one. I don’t know if this is just the result of loss of blood due to a clot or just from swelling. Is this normal for two days later and should I wait 24 hours or will it do damage if it is a clot and killing tissue?? Please help! I hate hospitals and don’t really want to go.

    • http://thesurvivaldoctor.com/ James Hubbard, MD, MPH

      I’d suggest checking with your regular doctor or an urgent care clinic. Unless the swelling is bad enough to be pressing on a nerve or circulation, I’d be more concerned about what you might have injured when you fell. Also, in general, the more you’re on your feet the more swelling but whatever you do, I certainly wouldn’t expect it to start dissipating before a week or so. Please read the post about the low risk of a bruise, at least initially, giving you the kind of clot that goes to your lung.

      • Krissy T

        Seriously, thank you for getting back so quick! I saw that you had gotten back to someone quickly and was hoping for the same :) After I sent this out I got up for a bit and walked around my garden, picked a couple of tomatoes and feel an ache in my calf. This ache is similar to the ache I had when I had (unbeknownst to me at the time) a blood clot lodged in my calf. I had gall bladder surgery and as a newly certified massage therapist decided to massage it and then noticed serious pain as though my muscle had torn and started getting short of breath (I have asthma so this wasn’t to unlike an asthma shortness of breath). My inhaler didn’t work and so the next morning went to the ER and the CT scan showed I that I had 3 PE’s. I can’t help but think of how horrible it was getting admitted to the hospital for 5 days and warfarin shot in my belly. I bring this up only because I’m hoping you will say that as long as I don ‘t break up the clot by massaging my calf, that my body will just absorbed the clot in a few days?
        BTW I had a hereditary test to be sure excessive clotting wasn’t in my DNA? and it wasn’t found to be the issue. I believe it was the birth control I was on, and I’m currently not on any.

        • http://thesurvivaldoctor.com/ James Hubbard, MD, MPH

          Of course you’re worried then, and you should be more cautious since you may be prone to blood clots, for whatever the reason. . And, you give a great example of one of the reasons I can only give general information and am not able to make a specific diagnosis and specific treatment for individuals I haven’t seen in person. I had no idea you’d had the history (and, of course, you can’t possibly tell me everything I might need to know in a post comment). Be careful and, again, remember, although trauma does put you at increased risk for the deep vein blood clots, if the blood just clots in the soft tissue outside of a blood vessel, that
          s not the type that will break off and lead to a clot in the lung (PE). Thanks.

  • Centre left above hip bone

    I Hit edge of table, centre left above the hip bone, and I thought of sharing the experience with the bruised community :)
    First and second day swollen and painful, third day noticeable 50% approx. reduction in swelling and no pay as long as I don’t disturb it, fourth day I noticed what you have mentioned in your article that discolouration is spreading downwards just a little.
    Also noticed today that I could sleep on my left side again, by slowly lying down on my left without causing the skin to move along the friction with the bed, but when that happens and if I press on the area intentionally I feel very slight stinging sensation that goes away in seconds after releasing the friction/pressure.

    One last note is that today I slept on my left swollen side and when I woke up noticed that instead of having a round lump, now it has become a flat lump that became rounded again during the day! A mind of it’s own.

    Thank you James for the effort, and everyone for sharing.

    • http://thesurvivaldoctor.com/ James Hubbard, MD, MPH

      Thanks for sharing,

  • shirly

    I have had several bruises on my lower leg then a few days later it shows bigger & darker on my thigh then disappears & end up very sore in that area. Do I need to worry if its going to be a blood clot that travels to my heart & lungs?

    • http://thesurvivaldoctor.com/ James Hubbard, MD, MPH

      If they’re recurrent, and not just a one time thing, I’d get it checked out to see why it’s happening. In general, bruises that you see, with no other symptoms, would not make me think of deep blood clots. However, everyone is different. I’d be more worried about why they’re occurring more than once, if there’s no trauma. Bleeding disorder? Medication?

  • Gorgia

    Got a lump on my inner forearm a while ago, shocking me because I didn’t realize that trying persistently to no good end to start a weed-whacker could cause such trauma, I didn’t notice I had done it till I saw the bigger than a golf ball sized lump on my inner arm later. Even later the lump dissipated and bruised something just as big looking but in a shape like a German Shepherd face. Also the meaty part of my thumb was bluer than usual. Now the bruise is much less, just where the ears of the “face” was… but my upper arm and bicep and arm muscle in general is achy as all be especially after flexing my muscle in the slightest to do things. I was worried this meant a blood clot could be travelling up toward my brain or somewhere, as the pain had reached the inner part of my bicep arm-area. That’s a ridiculous worry right? Guess time will tell. Thanks for mentioning the “rare as hens teeth” idiom.

    • http://thesurvivaldoctor.com/ James Hubbard, MD, MPH

      Gorgia, probably you strained your biceps muscle as well. Sometimes people rupture the biceps tendon, which causes a “popeye” type, noticeable bulge in the muscle when you flex it.

  • Guest

    photo

  • Guest

    heres a photo

  • Jill Fleetwood

    I went wakeboarding this weekend, for the first time in years. Afterwards, I saw this large bruise below the back of my knee. I’m not sure when this happened. It’s impossible for the board to hit me right there, and I didn’t have a hard fall. I literally asked the driver to stop and slowly let go into the water. It is swollen (bumped out) and about 2″ across and 2″ tall. Could this be a blood clot as in deep vein thrombosis? I’m going to schedule a doctor’s appointment, but am a little worried. It is very tender to the touch and a little painful just sitting there.

    • http://thesurvivaldoctor.com/ James Hubbard, MD, MPH

      Jill, I can’t diagnose you specifically, but in general something like that is more like I describe in the post.

  • Dean

    Hey,

    i had a haemotema diagnosed a couple of weeks back

    Playing soccer I got a kick which swelled something rotten initially and was very ore and stiff.

    Now the swelling has subsided somewhat, however I’m left with a very painful tennis ball shaped thing on my leg which throbs constantly and severely hurts when I walk. Could this be a clot?

    • Dean

      Sorry for the double post, thought I’d deleted the guest one

  • Dean

    Hey,

    I took a kick to the thigh around 11 days ago playing football (soccer).

    Initially it swelled up something rotten,….(see first pic)

    I had this diagnosed as a haemotoma and was told the bruising would ease up along with the pain over time, and that the pain shouldn’t last too long, and just to take ibuprofen for the pain.

    Although the bruising had subsided somewhat, I’m now left with a thick, solid tennis ball shaped thing on my leg which is VERY painful, constantly throbbing (the pain with the swelling was more related to stiffness than throbbing). Is this normal? Would this be a sign of a clot? (see 2nd pic)

    • http://thesurvivaldoctor.com/ James Hubbard, MD, MPH

      See the post part about what if the bruise is swollen. But since the swelling is so large and painful, I’d see a doctor to have it checked out.

  • Becky

    Hi there…. I had a vein randomly swell and then rupture. They told me it was a vericose vein rupture even though I never had a vericose vein there that I was aware of. It’s on the inside of my left knee. Anyway, in a matter of minutes it swelled (the vein) then ruptured. I experienced itching first then saw the swelling of the vein and bruising. I now have a very large bruise but no knot. This just weirded me out a bit because the doctors couldn’t tell me why a vein would rupture like that. My thought process was that maybe a clot was blocking the vein and caused it to suddenly swell then rupture. Anyway… I’ve been looked at by two different docs neither of which are concerned about a clot. My leg is slightly achey in general but they are telling me it’s normal…. It doesn’t seem normal but I guess I’ve not had a vein rupture before. I spent many hours in a car the precious week driving from Florida to Illinois and back for a trip to disney world. Even with that my doctors are not concerned with a clot. Should I insist on some kind of further check or just accept this?

    • Synthia Fagen

      Becky, I had this EXACT same thing happen to me in the exact same place, yesterday. Can you write an update here? Any other findings? Has it happened since? Thank you!

    • http://thesurvivaldoctor.com/ James Hubbard, MD, MPH

      Becky, I can’t tell you specifically in your case but, in general, sometimes a vein just leaks for no apparent reason. Maybe the wall got a little weak or was defective. Also, a varicose vein has to start at some point in time. In other words, one day there’s nothing, the next day there’s a swelling or bulge in a vein. If you’re really worried something’s wrong, you could insist on a duplex ultrasound of the area however, without much in the way of symptoms, insurance may or may not pay for it.