Subgaleal hematoma in a child, without skull fracture

Subgaleal Abscess Following Staphylococcal Cellulitis in a 10-Month-Old Child: A Diagnostic Challenge for the Clinician

Subgaleal abscess is an extremely rare and unusual presentation of head and neck infections and has been reported to occur following scalp infections, head trauma, sinusitis, septicemia, scalp monitoring, and surgical interventions. We report a 10-month-old child who presented with cellulitis around a pustule on the right forehead of three days duration. It was initially treated with oral cloxacillin for five-days. However, the child went on to develop a high continued fever on the day of discharge and remained febrile and unwell for seven days until a subgaleal abscess was identified and surgical drainage was performed. Pus cultures grew Staphylococcus aureus, which was sensitive to flucloxacillin. Following drainage of the abscess and change of antibiotics to intravenous flucloxacillin, fever completely subsided and the child made a complete clinical recovery. This report highlights the importance of having a high clinical suspicion of this rare complication in children with continuing high spikes of temperature following skin infections in the head region.

Subgaleal hematoma evacuation in a pediatric patient: A case report and review of the literature

Background:

Subgaleal hematoma (SGH) is generally documented within the neonatal period and is rarely reported as a result of trauma or hair braiding in children. While rare, complications of SGH can result in ophthalmoplegia, proptosis, visual deficit, and corneal ulceration secondary to hematoma extension into the orbit. Although conservative treatment is preferential, expanding SGH should be aspirated to reduce complications associated with further expansion.

Case Description:

A 12-year-old African-American female with no recent history of trauma presented with a chief complaint of headache along with a 2-day history of enlarging 2–3 cm ballotable bilateral frontal mass. Hematological workup was negative. The patient’s family confirmed a long history of hair braiding. The patient was initially prescribed a period of observation but returned 1-week later with enlarging SGH, necessitating surgical aspiration.

Conclusion:

SGH is rare past the neonatal period, but can be found in pediatric and adolescent patients secondary to trauma or hair pulling. Standard workup includes evaluation of the patient’s hematological profile for bleeding or coagulation deficits, as well as evaluation for child abuse. Although most cases of SGH resolve spontaneously over the course of several weeks, close follow-up is recommended. The authors present a case of a 12-year-old female presenting with enlarging subgaleal hemorrhages who underwent surgical aspiration and drainage without recurrence. A literature review was also conducted with 32 pediatric cases identified, 20 of which were related to hair pulling, combing, or braiding. We review the clinical course, imaging characteristics, surgical management, as well as a review of the literature involving subgaleal hemorrhage in pediatric patients and hair pulling.

Pediatric head trauma

Head injury in children accounts for a large number of emergency department visits and hospital admissions. Falls are the most common type of injury, followed by motor-vehicle-related accidents. In the present study, we discuss the evaluation, neuroimaging and management of children with head trauma. Furthermore, we present the specific characteristics of each type of pediatric head injury.

Calcified subgaleal hematoma with secondary cranial deformity in a patient with Kasabach-Merritt phenomenon

We present here the case of a 25-month-old boy who, in conjunction with his preexisting Kasabach-Merritt phenomenon (KMP), developed a massive calcified subgaleal hematoma (SGH) with secondary cranial deformity. Kasabach-Merritt phenomenon is a rare condition that involves a secondary consumptive coagulopathy in the setting of congenital hemangiomatous lesions. The vascular lesions of KMP are often large, singular, and cutaneous, but may also be diffuse, and involve internal structures. Subgaleal hematomas are a rare condition, most frequently observed in neonates as a complication of instrument-assisted delivery. There have been few cases reported beyond the perinatal period, but those that are present within the literature have typically resulted from some instance of minor trauma to the scalp. Most cases resolve spontaneously and without complication. However, our patient's SGH developed into a large, organized, and calcified lesion, likely with some contribution from his hematologic deficit. In addition, this subgaleal lesion resulted in a cranial deformity, ultimately requiring surgical evacuation and reconstruction. We believe the case presented here represents the first report of an SGH in the setting of KMP.

Subgaleal hematoma in a child with Sturge-Weber syndrome: to prevent stroke-like episodes, is treatment with aspirin advisable?

CASE REPORT

A subgaleal hematoma (SGH) occurred in a young patient with Sturge-Weber syndrome (SWS) who was treated with aspirin after a mild head trauma.

MATERIALS AND METHODS

A 4-year-old child with SWS, who was chronically treated with aspirin at an antiplatelet dosage of 3 mg/kg per day, presented with extensive SGH and significant anemia after a mild head trauma.

RESULTS AND CONCLUSION

It is conceivable that the minor head trauma and chronic use of aspirin caused the SGH. Based on this event, the chronic use of aspirin in young patients with SWS, as suggested to prevent stroke-like episodes, is disputable.

Sub-aponeurotic fluid collections in infancy

AIM

To describe the radiological features and natural history of sub-aponeurotic fluid collections presenting after the neonatal period.

MATERIALS AND METHODS

All cases of sub-aponeurotic scalp fluid collection presenting to the radiology department between June 1996 and June 2000 were reviewed. Note was made of the birth history, the radiographic and ultrasound features and the natural history (including any treatment) of the collection.

RESULTS

Seven cases of sub-aponeurotic fluid collections were identified. There were six infants who presented 3.5-18 weeks (mean nine weeks) after delivery, four of whom had had ventouse-assisted delivery. The last case was in a seven-year-old child who presented one month after minor head trauma. Clinical examination revealed non-tender, soft, mobile and fluctuant scalp swellings in all patients. Ultrasound identified sonolucent fluid collections of between 5 and 24 mm depth in the sub-aponeurotic space. No skull fractures were identified. Six patients were treated conservatively and one had fluid aspirated and a compression bandage applied. All cases resolved 2-24 weeks after diagnosis and there were no long-term sequelae.

CONCLUSION

Sub-aponeurotic scalp collections presenting after the neonatal period are usually associated with ventouse-assisted delivery ultrasound is useful for diagnosis. The condition is benign and resolution occurs with conservative treatment.

Massive subgaleal hematoma following minor head trauma

A 23-month-old child developed massive head swelling secondary to a subgaleal hematoma several days following minor head trauma. When seen in the emergency department, the child was felt to be otherwise well and hemodynamically stable and was discharged with close follow-up. The hematoma subsequently resolved over the ensuing two weeks. This case represents an uncommon, but dramatic complication of minor head trauma and serves to illustrate the need for physicians to recognize this entity as well as manage it effectively. The major pitfalls in managing these patients are failure to recognize this entity and, particularly in the infant, failure to carefully assess the hemodynamic status.