HEMORRHAGE (synonym: hemorrhage, extravasate) — accumulation of the blood which streamed from vessels in fabrics and cavities of an organism. The streamed blood can move apart and stratify fabric elements, impregnating and destroying a parenchyma. Similar To. call hemorrhagic infiltration. Extensive To., surrounded with the dense fabric forming the capsule call hematoma (see). Formation of a hematoma quite often is followed by amotio or destruction of fabric. Flat To. in the thickness of skin and mucous membranes call bruises, small spotty and dot hemorrhages in skin, mucous and serous membranes — petechias or ecchymomas. The multiple hemorrhages of petekhialny type in substance of a brain which are observed at a fatty vascular embolism of a brain at sudden disturbance of outflow of blood in system of an upper vena cava, at acute inf. diseases, carry the name of a hemorrhagic purpura. Massive single-step To. in some bodies which are followed by sharp disturbance of their function call an apoplexy. The apoplexy of a brain at a stroke is most often observed (tsvetn. fig. 1 and 2), adrenal glands, apoplexy of an ovary (see).
In a basis To. the same factors lie, as at bleedings (see). The reason To., as a rule, disturbances of an integrity of a wall of heart or vessels, the increased its permeability are. Hemorrhages from a gap (haemorrhagia per rhexin) are observed at injuries, and also defeat of cardiovascular system any patol, process. Ruptures of walls of heart in a zone are that heart attack (see), Nadklapanny gap aortas (see) because of a necrosis of its average cover at an idiopathic hypertensia, gaps aneurisms (see), including and aneurisms of vessels of a brain (see), ruptures of the intense capsule of bodies (liver, spleen).
Other reason To. corrosion of a vascular wall (haemorrhagia per diabrosin) is cells of a malignant tumor, fusion it under the influence of proteolytic enzymes of pus, tubercular process, under the influence of digestion by a gastric juice, napr, walls of vessels in day of an ulcer or erosion of a stomach (tsvetn. fig. 3), etc.
To. can arise by emigration (haemorrhagia per diapedesin). These To., as a rule, have an appearance of the petechias and ecchymomas which are located in the form of a rim in a circle of a capillary or an arteriole — ring-shaped To, Diapedetic To. (see. Emigration ) arise in fabric of parenchymatous bodies, but are observed preferential in skin and under serous covers, and also in the thickness of mucous membranes. Similar To. meet at many inf. diseases (sapropyra, malaria, etc.), avitaminosis, leukoses, acute fibrinolysis, and also intensive anticoagulating care (tsvetn. fig. 4). In such cases To. quite often accept widespread character, and then speak about hemorrhagic diathesis.
Petekhialny diapedetic To. (ecchymomas) have great diagnostic value. So, subendocardial ecchymomas of a left ventricle of heart (Minakov's spot) are characteristic of an acute hypoxia of any etiology, To. in a mucous membrane of a stomach — at deaths door from cooling, a petechia of a conjunctiva of an eyeglobe — at a sapropyra (see. Kiari — Avtsyna a symptom ) and sepsis, multiple petechias in skin of a breast — at a prelum of a thorax etc.
To. arise not only during lifetime, but also posthumously. Posthumous To. can result from an injury during 1 — 2 days after a cardiac standstill. Especially often they are formed at the closed cardiac massage applied for the purpose of resuscitation. Differential diagnosis intravital and posthumous To. presents considerable difficulties.
The blood which streamed in fabric is curtailed and exposed to further transformations. The hemoglobin which is released from the broken-up erythrocytes rezorbirutsya partially by macrophages, turning into the hemosiderin defined in gistol, cuts by reaction to iron; other part of hemoglobin without participation of cellular elements turns into Gematoidin, located, as a rule, in the central sites of a hematoma. Gematoidin in the subsequent can be transformed to a bilious pigment — bilirubin. Discoloration of skin bruise from purple-red to blue (hemosiderin) and yellow is connected with transformation of hemoglobin (bilirubin). Parcels of fibrin, are exposed to a rassasyvaniye or the organization and over time are replaced with connecting fabric.
A wedge, manifestations To. are defined by their localization, speed of development and the size.
To. in a brain are characterized defined nevrol, the symptomatology caused by localization. Special hazard to life is posed To. in a trunk part of a brain and extensive To. in the field of subcrustal nodes with break in cerebral cavities. The rupture of aneurism of an artery of a brain conducts to extensive subarachnoidal To. Hemorrhages in a soft meninx at arterial aneurism quite often happen repeated. At a craniocereberal injury there can be a subdural hematoma which is followed characteristic faznostyo a wedge, currents; directly after an injury there can be a period of imaginary wellbeing which is replaced by coma in process of increase of volume subdural
K. K. in vitals can not cause essential blood loss and a circulator hypoxia. Only the massive retroperitoneal hematoma arising owing to injuries of large arteries of an abdominal cavity or a rupture of aneurism of a ventral aorta is followed by blood loss to 3 — 4 l.
To. in fabric it is quite often combined with To. in a perigastrium: pleural (see. Hemothorax ), belly (see. Hemoperitoneum ), a pericardium (see. Hemopericardium ), went. - kish. path. Wedge, a picture in these cases is defined generally by degree blood losses (see), and To. in a cavity of a pericardium, usually connected with disturbance of an integrity of a cardial cavity or intra pericardiac department of an aorta, fatally.
Diapedetic To. in skin and mucous membranes, being display of a serious general illness, as a rule, in itself do not cause serious complications. However their localization in vitals, napr, in a brain, can be the reason of heavy disturbances. A mucous membrane of a stomach in a zone petekhialny To., as a rule, is exposed to an autolysis under the influence of salt to - you and peptic enzymes of a gastric juice with formation of the erosion and acute ulcers which are complicated in turn by gastric bleeding.
At extensive To. there is jaundice of integuments and mucous membranes owing to transformation of hemoglobin into bilirubin. The resorption of hemoglobin from extensive hematomas is followed haemoglobinaemia (see) and haemoglobinuria (see), and at simultaneous damage of large muscular arrays — a myolysis and myoglobinuria (see). Outcomes are possible To. in suppuration, calcification, a necrosis.
At calcification To. it is found at a X-ray analysis usually 1 — 2 month later after an injury, and sometimes and slightly earlier in the form of a conglomerate of uneven spotty or continuous shadows (fig. 1 and 2). In the beginning calcification is represented an oblakovidny, low-intensive shadow, further such shadows are condensed, increase in volume. Usually calcification is located in muscles, separately from a bone.
Calcification To. often turns into ossification as a metaplasia or through a cartilaginous stage. Rentgenol, a picture of ossification To. sometimes gains lines of looking alike an osteosarcoma.
At differential diagnosis the injury in the anamnesis, an originality rentgenol, pictures calciphied is considered To. — lack of communication with a bone, typical localization of an osteosarcoma in departments of a bone with thin layer of muscles (e.g., in epicondyles of a femur) whereas the osteogenesis arising in the field of a hematoma is found usually in the field of thick layers of muscles. Difficulties in diagnosis are possible in cases of the ossification which intimately merged with a periosteum.
The majority small To. does not demand special treatment. At massive To., caused, e.g., by damage or a spontaneous rupture of aneurism of large arteries, etc., the emergency operative measure is shown.
Bibliography: Dyachenko V. A. Radiodiagnosis of calcifications and heterogeneous okosteneniye, M., 1960, bibliogr.; Isakov Yu. V. Acute traumatic intracranial hematomas, M., 1977, bibliogr.; Koltover A. N. of ides of river. Pathological anatomy of disturbances of cerebral circulation, M., 1975, bibliogr.; Lebedev V. V., Ioffe Yu. S. and Ostrovskaya I. M. Surgery of acute brain strokes, M., 1970, bibliogr.; Strukova. I. Pathological anatomy, M., 1971.
N. K. Permyakov; V. A. Dyachenko (rents.).