Bilateral subperiosteal haemorrhage in a newborn

Orbital Subperiosteal Hematoma in the Newborn Causing Unilateral Proptosis: Ultrasound as First-Line Imaging Modality

“…The majority of these cases were unilateral; bilateral involvement was described in two cases. 6,7 The mechanism of neonatal subperiosteal orbital hemorrhage is not entirely clear. A history of traumatic delivery has often been quoted.…”

“…The loose attachment of the periosteum to the bone in the superolateral aspect of the orbit in infants may explain the characteristic location in all reported cases, including the two cases presented here. [2][3][4][5][6][7][8]10 In one previous case, a subperiosteal hematoma with periosteal defect leading to leaking of blood into the orbit was found at the time of surgical exploration. 3 Coagulopathy does not seem to be common as evident from the normal results of coagulation screens obtained in the reported cases.…”

“…3 Coagulopathy does not seem to be common as evident from the normal results of coagulation screens obtained in the reported cases. [2][3][4][5][6][7][8] Administration of vitamin K at birth needs to be ascertained in all cases. In one infant, preexisting coagulopathy and thrombocytopenia were aggravated by anticoagulation for extracorporeal membrane oxygenation (ECMO) for cardiorespiratory failure; 5 this infant developed proptosis secondary to subperiosteal orbital hematoma, which was confirmed by contrast-enhanced MRI and which resolved spontaneously.…”

“…5,6,8 Of the seven cases reviewed, six, including the second infant in our series, had undergone an orbital CT at some stage; in two cases, this was the only imaging modality. [2][3][4][5][6][7][8] Orbital MRI was used in three cases, in two of which, it was the only imaging modality. 5,8 The advantage of MRI in this context is the lack of radiation exposure, ability to reliably exclude an orbital encephalocele, and to differentiate blood at different stages of degradation.…”

“…16 An additional clue for retroorbital hemorrhage as the underlying cause for proptosis in the newborn is a normal third trimester ultrasound, possibly evidence of periorbital trauma with instrumental delivery and conjunctival congestion or frank subconjunctival hemorrhage. [2][3][4][5][6][7][8] The management of retroorbital hemorrhage is largely conservative with an aim to prevent exposure keratitis. However, evacuation of the hematoma has been performed to reduce pressure on the optic nerve or because of diagnostic uncertainty in three of the seven reported cases and in the second case in our series.…”