A calcified hematoma is a long-term consequence of an initial injury, representing a collection of clotted blood that has hardened over time. A hematoma is a localized collection of blood outside of blood vessels, and calcification is the body’s natural healing process involving the deposition of calcium salts into the residual mass of the blood clot. While the idea of a hardened mass of old blood may sound concerning, the vast majority of calcified hematomas in soft tissue are not inherently life-threatening. The main concern shifts to whether the hardened mass is causing local symptoms or is located near a sensitive structure.
Understanding the Formation of Calcified Hematomas
The process begins with trauma causing blood vessels to rupture and blood to pool in a confined space. In most cases, the body naturally reabsorbs this pooled blood over days or weeks. If the body fails to fully clear the collection—often due to poor circulation, repeated trauma, or insufficient resolution—the remaining clot becomes walled off and organized.
This organization phase involves the accumulation of fibrotic tissue around the non-reabsorbed blood. Over months or even years, this chronic mass undergoes dystrophic calcification, where calcium phosphate and other mineral salts are deposited within the connective tissue membrane. This process causes the mass to harden. Calcification most commonly develops six months to several years after the original injury and is the body’s passive attempt to stabilize and contain the old, non-functional tissue. This hardening can occur in soft tissues, such as muscles, or within the layers surrounding the brain, such as a chronic subdural hematoma.
Assessing the Potential Risks
For most calcified hematomas located in soft tissue, such as the thigh or arm, the mass itself is benign and not dangerous. These localized masses may cause a palpable, firm lump that is often tender to the touch. The primary risks associated with soft-tissue calcification are localized symptoms like persistent pain, discomfort, or restricted range of motion, especially if the mass is large or near a joint.
A significantly different risk profile exists for calcified chronic subdural hematomas (CCSDH), which occur between the layers covering the brain. Because the brain is housed in a rigid skull, even a small lesion can create problems due to “mass effect.” This means the hardened mass can compress surrounding brain tissue, potentially leading to neurological symptoms.
In rare instances, a CCSDH can cause symptoms such as seizures, intellectual deficits, headaches, or weakness due to pressure on the brain. The calcified lesion may also adhere tightly to the dura mater and the underlying cerebral cortex. This adherence makes surgical removal more technically challenging and carries a small risk of injuring the brain tissue. Furthermore, calcified hematomas can sometimes mimic the appearance of other lesions, such as tumors, on imaging, making proper diagnosis important.
How Doctors Diagnose and Monitor
When a calcified hematoma is suspected, medical professionals use imaging techniques to confirm the presence of calcium within the lesion. The computed tomography (CT) scan is the investigation of choice because it excels at visualizing dense structures like calcium. On a CT scan, the calcium deposits appear as hyperdense, bright areas, confirming the diagnosis.
X-rays can also reveal the hardened mass, particularly in soft tissues, but CT provides more detailed, cross-sectional information about the size and exact location. Magnetic resonance imaging (MRI) is often used alongside CT, especially for intracranial lesions. MRI helps assess the relationship between the calcified mass and surrounding soft tissues, such as the brain, and determines the degree of adherence to the brain tissue, which is important for surgical planning. For calcified hematomas that are not causing any symptoms, the standard approach is “watchful waiting.” Monitoring involves periodic imaging to ensure the lesion remains stable and does not grow or change over time, reflecting the stable, non-progressive nature of calcification.
Indications for Medical Intervention
Active medical intervention is generally reserved for calcified hematomas that become symptomatic. The decision to intervene is heavily influenced by the lesion’s location and the degree of functional impairment it causes. For soft-tissue hematomas, intervention is indicated if the mass causes significant, persistent pain or restricts the normal range of motion of a joint. Physical therapy is often the first line of treatment to reduce pain and restore mobility.
For calcified chronic subdural hematomas, the threshold for intervention is neurological symptoms or significant mass effect observed on imaging. Symptoms like refractory headaches, seizures, or progressive muscle weakness suggest the mass is pressing on sensitive brain structures and requires treatment. The most common intervention for symptomatic calcified hematomas is surgical excision, which involves carefully removing the hardened mass. The goal of surgery is to decompress the area and alleviate pressure on surrounding tissues. Surgical techniques, such as craniotomy for intracranial lesions, must be performed with care due to the potential adherence of the calcified capsule to underlying structures. Surgical correction is also considered the treatment of choice for lesions causing significant cosmetic deformity, particularly in the skull.