Point-of-care Ultrasound to Distinguish Subgaleal and Cephalohematoma: Case Report

Abstract

Introduction: Cephalohematomas generally do not pose a significant risk to the patient and resolve spontaneously. Conversely, a subgaleal hematoma is a rare but more serious condition. While it may be challenging to make this diagnostic distinction based on a physical examination alone, the findings that differentiate these two conditions can be appreciated on point-of-care ultrasound (POCUS). We describe two pediatric patient cases where POCUS was used to distinguish between a subgaleal hematoma and a cephalohematoma. Case Reports: We describe one case of a 14-month-old male brought to the pediatric emergency department (PED) with concern for head injury. A POCUS examination revealed a large fluid collection that did not cross the sagittal suture. Thus, the hematoma was more consistent with a cephalohematoma and less compatible with a subgaleal hematoma. Given these findings, further emergent imaging was deferred in the PED and the patient was kept for observation. In the second case an 8-week-old male presented with suspected swelling over the right parietal region. A POCUS examination was performed, which demonstrated an extensive, simple fluid collection that extended across the suture line, making it more concerning for a subgaleal hematoma. Given the heightened suspicion for a subgaleal hematoma, the patient was admitted for further imaging and evaluation. Conclusion: Point-of-care ultrasound can be used to help differentiate between a subgaleal hematoma and a cephalohematoma to risk-stratify patients and determine the need for further imaging.

Hemorragia Subgaleal Neonatal

“…9 • JULHO/SETEMBRO 2022 • 265 SGH is a rare and potentially lethal condition in newborns, due to the rupture of emissary veins, causing accumulation of blood between the epicranial aponeurosis and the periosteum. [1][2][3] It should be considered in the presence of diffuse fluctuant swelling, that extends widely and crosses suture lines. [2][3][4] SGH is more frequently associated with vacuum/ forceps assisted delivery, but may also occur spontaneously, with an incidence of approximately 0.4/1000 spontaneous births.…”

“…[2][3][4] SGH is more frequently associated with vacuum/ forceps assisted delivery, but may also occur spontaneously, with an incidence of approximately 0.4/1000 spontaneous births. [1][2][3] Massive blood loss into that space may lead to acute anemia, hypotension, acidosis and eventually, hypovolemic shock. 1,3 Early detection and close monitoring, with prompt administration of fluids and/or blood products are mandatory.…”

“…[1][2][3] Massive blood loss into that space may lead to acute anemia, hypotension, acidosis and eventually, hypovolemic shock. 1,3 Early detection and close monitoring, with prompt administration of fluids and/or blood products are mandatory. 3 Imaging study corroborates the diagnosis.…”