[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Forensic medicine](https://durgical.com/en/forensic-medicine/) › [Mechanical injuries](https://durgical.com/en/forensic-medicine/areas/injuries/) › Bruises and haematomas: recognising them, and why colour cannot date them

# Bruises and haematomas: recognising them, and why colour cannot date them

- Finding

A bruise is blood escaped from broken vessels under intact skin; its colour cannot tell reliably when it happened.

Updated Nov 5, 2026

## Key points

- Bruise: blood infiltrating tissues under intact skin; haematoma: a collection of blood.
- Colour does NOT date a bruise: any colour can be seen in recent or old bruises.
- It can appear hours later or away from the impact (blood tracks along tissue planes).
- Patterned bruises: fingertips, "tramline" bruises from rod-like objects, bites.
- On dark skin it may be faint or invisible: its absence does not exclude a blow.

On this page

- The basics Key points
- What it is
- How to tell it apart
- How to recognise it
- How it forms
- Step by step
- Next step: what to do and document
- Common mistakes
- Elsewhere in DurgiPedia

- Study Test yourself

- Connections Connections

## What it is

A bruise (contusion, equimosis) is blood leaking from small vessels broken by an impact into the tissues, with the skin intact. When the blood collects into a palpable mass it is a haematoma. It is the typical mark of a blunt object and can reproduce its shape. Two key ideas for exams and practice: a bruise may appear late or away from the point of impact, and its colour cannot date it reliably. A systematic review concluded that estimating the age of a bruise from its colour has no scientific basis.

## How to tell it apart

- Versus livor mortis: on incision a bruise shows blood infiltrated into the tissues; livor stays inside the vessels.
- Versus mimics: congenital pigmented patches, clotting disorders, vasculitis.
- Versus an abrasion: in a bruise the epidermis is intact.
- No bruise at the site of the blow does not contradict the account: it may appear later or elsewhere.

## How to recognise it

- A red, purple, green or yellow patch under intact skin that does not blanch on pressure.
- Haematoma: palpable swelling from the collection of blood.
- Patterned bruises: round fingertip marks, two parallel lines from a cylindrical object, the arcs of a bite.
- Bruising at a distance: periorbital with a skull-base fracture, or in lower areas as blood tracks down.

## How it forms

- An impact breaks small vessels and blood infiltrates the dermis, the subcutaneous tissue or deeper planes.
- Size depends on force, the tissue (loose versus firm) and the person's clotting.
- Over days haemoglobin breaks down and the colour changes, but at very different rates between people and injuries.

## Step by step

- Locate, measure and describe each bruise separately: shape, colour and pattern.
- Photograph with a scale; if possible, repeat the photographs on the following days.
- Record the colours seen without giving them a date.
- Examine fully if there is a suspicious pattern or injury to the neck, chest or abdomen.
- If the first exam shows no bruise and the event was recent, re-examine the next day.

## Next step: what to do and document

- Describe and photograph; do not write that a bruise "is X days old" from its colour.
- With bruising of the face, neck, chest or abdomen after a blow, rule out internal injury and do not discharge in a hurry.
- In children, older adults or victims of violence, compare the pattern with the account, start the protection pathway and make the mandatory notifications.
- Arrange a repeat exam if injuries may not yet be visible, and also record when no bruise is seen.

## Common mistakes

- Dating a bruise by its colour in a medico-legal report.
- Concluding there was no blow because no bruise is seen at the first visit.
- Attributing a congenital patch or a clotting disorder to abuse without investigating it.
- Writing "multiple bruises" instead of describing each one.

## Test yourself

Think of the answer, then tap the question to see it.

## Can the age of a bruise be estimated accurately from its colour?

No. A systematic review (Maguire 2005) concluded that ageing bruises by colour has no scientific basis: any colour appears in both recent and old bruises.

## Why may no bruise be visible at the site of a blow?

Because it can take hours to appear, track to another area along tissue planes, or be hard to see on dark skin.

## What do two parallel lines of bruising separated by normal skin suggest?

A blow with a cylindrical or rod-like object (a "tramline" bruise).

## How is a bruise told from livor mortis on incision?

In a bruise the blood has infiltrated the tissues; in livor the blood is inside the vessels and washes away.

[Add to my cards (4)](https://durgical.app/estudiar/?add=/en/forensic-medicine/bruises-and-haematomas-recognising-them-and-why-colour-cannot-date-them/)

## Elsewhere in DurgiPedia

- [Mandatory reporting: public health, violence and abuse](https://durgical.com/en/medical-ethics/mandatory-reporting-public-health-violence-and-abuse/)
- [Hemorrhage: petechiae, purpura, ecchymosis, hematoma, and what blood loss does](https://durgical.com/en/general-pathology/hemorrhage-petechiae-purpura-ecchymosis-hematoma-and-what-blood-loss-does/)

## Connections

## Related 5

- [Abrasions](https://durgical.com/en/forensic-medicine/abrasions/)
- [Child maltreatment: signs that should raise concern](https://durgical.com/en/forensic-medicine/child-maltreatment-signs-that-should-raise-concern/)
- [Vital reaction: was the wound made in life?](https://durgical.com/en/forensic-medicine/vital-reaction-was-the-wound-made-in-life/)
- [Livor mortis (hypostasis)](https://durgical.com/en/forensic-medicine/livor-mortis/)
- [Examining a living victim of injury (lesiones personales)](https://durgical.com/en/forensic-medicine/examining-a-living-victim-of-injury/)

## Related conditions 3

- [Child maltreatment (physical abuse, abusive head trauma, neglect)](https://durgical.com/en/conditions/child-maltreatment/)
- [Intimate partner and sexual violence (mental-health care)](https://durgical.com/en/conditions/intimate-partner-and-sexual-violence/)
- [Elder abuse and neglect](https://durgical.com/en/conditions/elder-abuse-and-neglect/)

[← All of forensic medicine](https://durgical.com/en/forensic-medicine/)

Educational content on forensic and legal medicine; not legal advice and no substitute for the technical guides of Colombia's National Institute of Legal Medicine and Forensic Sciences. Laws change: each page links the official text and says when it was last checked. For a real case, follow the guide in force and ask the competent authority.

Sources: [Can you age bruises accurately in children? A systematic review (Maguire S, Mann MK, Sibert J, Kemp A)](https://pmc.ncbi.nlm.nih.gov/articles/PMC1720275/) (Archives of Disease in Childhood (PMC), 2005); [Trauma Forensics in Blunt and Sharp Force Injuries](https://pmc.ncbi.nlm.nih.gov/articles/PMC9802595/) (Journal of the West African College of Surgeons (PMC), 2022); [Blunt Force Trauma (StatPearls)](https://www.ncbi.nlm.nih.gov/books/NBK470338/) (NCBI Bookshelf, StatPearls Publishing, 2023).

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License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/forensic-medicine/bruises-and-haematomas-recognising-them-and-why-colour-cannot-date-them/