Many of my patients have asked me about forming dangerous blood clots, which can break off and go to your lungs, and be potentially fatal. These are called pulmonary emboli, and while they are extremely serious events, they are fortunately also quite rare.

Most blood clots form outside of a blood vessel after the tiny blood vessels are injured. These usually occur after some trauma, and represent leaking of blood into the surrounding tissues or joint. These are called hematomas, and are rarely a problem. Hematomas may develop routinely after surgery as well. The hematoma may make the surrounding tissues quite firm or hard, with a lump. After some time, there may be bruising, or discoloration, as the blood clot dissolves, and gets absorbed into the surrounding skin. Treatment for a hematoma involves the usual R.I.C.E.; rest, ice, compression, and elevation. Resist the urge to take an anti- inflammatory, like ibuprofen, as that medication can actually interfere with normal blood clotting.

A completely different process involving the clotting of blood can also occur, but this time it takes place inside the blood vessels. When it happens in a vein (the vessels leading back to the heart), it is called a deep vein thrombosis, or DVT. While theoretically they can form pretty much anywhere, most of these will form in the lower extremity (the calf, thigh or pelvis). A DVT is, as its name suggests, deep in the leg. These are not the same thing as varicose veins, which are on the surface of our legs. DVTs may be painful, with swelling, or more commonly can be totally without any symptoms.

DVTs can develop after periods of prolonged rest or immobilization, such as after recovering from major surgery, or even after a long airplane ride. Certain medications, such as birth control pills, can increase one’s risk. Fortunately, most DVTs come and go without a problem, as the body naturally dissolves the clot inside the vein. Rarely, however, the clot can break loose, where it travels back to the heart, and is then pumped out of the heart to the lungs. This clot can get stuck, and seal off a portion of the lung, preventing that part of the lung from doing its job. This is called a Pulmonary Embolus, or PE. Symptoms of a pulmonary embolus may include unexplained shortness of breath, or tightness or pain in the chest. If large enough, they can be fatal. A DVT or PE can be diagnosed with special scans, and is treated with a variety of blood thinners, and may require prolonged therapy to prevent reoccurrence.

Hematomas do NOT turn into DVTs or PEs. The process is totally different., and pulmonary emboli are rare. So don’t panic when your doctor tells you that swelling or bruising is a blood clot.

Dr. Noah Weiss

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