Definition:

Extravasation of blood into soft tissues,

due to rupture of blood vessels in the
S/C tissues.

NO loss of continuity of the Skin.

Cause
Blunt force
Eg. Blow with Fist, Stick, Cane etc.

Intra Dermal:
Bruise lies in Sub-epidermal layer.
Subcutaneous: (most common)
Bruise lies in S/C tissue, often in fatty layer Edges are
blurred
Deep:
Deeper to S/C tissue.
May take hours to 1-2 days to appear at the surface
Types of tissue involved
Soft, lax & vascular tissue (face, scrotum &
eyelids) Less Force produces Large Bruise.
Tissues, strongly supported & containing
fibrous tissue (Abdomen, back, scalp)
-- More force produces Smaller Bruise.



Types of tissue involved
Bruise on Scalp -- Better felt than seen.
Tissues overlying bone Bruise is more marked


Age
Children & Elderly - Bruise easily
Child - Soft tissue & Delicate skin
Elderly - Loss of S/C supportive tissue &
CVS changes.
Elderly - Bruise takes more time to heal.

Gender
Women bruise easily ---
Tissues are Delicate & S/C fat is more.
Obese people - Bruise Easily
Tissues are Delicate.
Skin Color
Fair skin - Bruise is clearly seen.
Dark Skin - Better felt than seen.
Natural Disease
Atherosclerosis, Purpura, Leukemia,
Hemophilia, Scurvy, Vit. K deficiency
Bruises are prominent after minor trauma



Ectopic/Migratory Bruise
Shifting of blood due to Gravity
Bruises appears at a site other than the site of
injury e.g. black eye.
Site of Bruise - different from Site of trauma

Bruise indicates the Nature of weapon
Blow with a Rod, stick or a whip
Two parallel, linear Bruises. Intervening skin
appears normal (Railway line / Tram line Contusion )

Mechanism:
Edges of the Rod - Drag the skin downwards -
Traction tear of marginal blood vessels.
Center of the Rod - Compresses the skin-
Little or No damage to underneath vessels

Injured marginal zones appear as 2 lines of Bruise
Internal organs can also get contused;
Contusion in vital centers can be fatal.
Duration Color Pigment
Fresh Reddish (oxygenated blood)
Few Hrs to 3 days Bluish (carboxy Hb)
4-5 days Bluish Black to Brown Hemosiderin
5-6 days Green Biliverdin
7-12 Yellow Billirubin
2 wks Normal
Subconjunctival hemorrhage
NO Color change - Hb remains oxygenated by air
Feature Hypostasis Bruise
1. Cause Distension of
vessels with blood
Rupture of vessels
2. Site Dependent
Body parts
Site of injury
3. Appearance Not elevated Often swollen
4. Margins Clearly defined Merge with
surrounding area
5. Color Bluish-purple color Color depends on
age of bruise
6. On incision Blood is seen in
vessels,
can be easily
washed away
Blood extravasated into
surrounding tissues,
cannot be
washed by water
8. Superimposed
abrasion
Not present May be present
9. M/E Blood is found within
blood vessels ,
NO inflammation
Blood is outside the blood
vessels,
Inflammation present
Age of Injury can be determined by color changes.
Degree of violence may be determined from the
size.
Patterned bruise- Identification of object/weapon
(whip, chain, cane or ligature)