Subgaleal Hematoma from Hair Combing

Falvo, Cathey; Filippo, J. Anthony San; Vartany, Alexandre; Osborn, E H

doi:10.1542/peds.68.4.583

Cited by 43 publications

(8 citation statements)

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“…Similar delays in presentation were seen in several case studies, ranging from 8 hours to 7 days 3–6,8,10 . The diagnosis of subgaleal hematoma in our patient was confirmed by noncontrast head CT, as well in most published cases 4,5,7–9 . No intracranial pathology was seen in any case using head CT 4–9 .…”

Section: Discussionsupporting

confidence: 88%

“…[3][4][5][6]8,10 The diagnosis of subgaleal hematoma in our patient was confirmed by noncontrast head CT, as well in most published cases. 4,5,[7][8][9] No intracranial pathology was seen in any case using head CT. [4][5][6][7][8][9] Skull radiographs were obtained in 54% (6 of 11) of cases reviewed, none of which identified any bony abnormality. 4,6,7,10 One case used head ultrasound in conjunction with skull radiographs to confirm subgaleal hemorrhage.…”

Section: Discussionmentioning

confidence: 79%

“…[4][5][6] As for the asymptomatic patients reviewed, two had their hematomas drained, three had surgical drains placed, and two had pressure dressings placed. [6][7][8][9] One patient developed bilateral proptosis, ocular pain, and limited ocular movement after placement of compression dressing. 8 The authors of that study suggested that the symptoms were a result of the excessive pressure placed by the drain, forcing fluid into the orbital region.…”

Section: Discussionmentioning

confidence: 99%

“…However, subgaleal hemorrhage is less frequently described outside of the neonatal period. Few publications exist describing subgaleal hemorrhage in older children or adolescents, but available reports describe subgaleal hemorrhage as a result of blunt trauma to the head or from radial traction, such as from hair pulling, hair braiding, or hair combing 1,4–10 . Chadwick's Child Maltreatment explains that “a shearing force may separate the scalp from the skull along the axis of the aponeurotic membrane, rupturing the emissary veins and causing traumatic hemorrhage into this potential space” 3 .…”

Section: Discussionmentioning

confidence: 99%

“…No intracranial pathology was seen in any case using head CT 4–9 . Skull radiographs were obtained in 54% (6 of 11) of cases reviewed, none of which identified any bony abnormality 4,6,7,10 . One case used head ultrasound in conjunction with skull radiographs to confirm subgaleal hemorrhage 10 .…”

Section: Discussionmentioning

confidence: 99%

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Subgaleal Hemorrhage Secondary to Child Physical Abuse in a 4-Year-Old Boy

Bowens

Liker

2020

Pediatr Emer Care

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Subgaleal hemorrhage is commonly described in the neonatal population but is a rare injury in young children and adolescents. Though infrequently seen, it can follow blunt head trauma or hair pulling. This case report details a 4-year-old African American boy with massive subgaleal hemorrhage and bilateral periorbital swelling and ecchymosis as a result of hair pulling in the setting of child physical abuse. The patient was evaluated in the emergency department for swelling of his scalp several hours after reportedly bumping his head on a chair. He was discharged home after a head computed tomography only confirmed soft tissue hematoma. The following morning, the findings progressed and he returned to the emergency department. He was triaged as a trauma and initially evaluated by the emergency physician, pediatric trauma surgeon, and pediatric neurosurgeon. Head computed tomography scan confirmed diffuse scalp edema without skull fracture or intracranial pathology. The child abuse specialty service was consulted for suspected child physical abuse. Their examination revealed numerous scattered bruises on the trunk and thighs, several of which were patterned. Local police investigation resulted in the patient's grandfather confessing to striking the patient with a belt and picking him up from the ground by his hair, the latter of which is a mechanism consistent with the patient's dramatic scalp and facial findings. The authors encourage consultation by a specialist in child abuse pediatrics for subgaleal hemorrhage and/or raccoon eyes in the presence of minor trauma, as well as thorough head-totoe skin examination for all children presenting with injuries.

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Section: Discussionsupporting

confidence: 88%

Section: Discussionmentioning

confidence: 79%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 3 more Smart Citations

Subgaleal Hemorrhage Secondary to Child Physical Abuse in a 4-Year-Old Boy

Bowens

Liker

2020

Pediatr Emer Care

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Childhood Subgaleal Hematoma Following Minor Head Trauma

Kuban¹

1983

Arch Pediatr Adolesc Med

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Mechanical and Thermal Injury

Kennedy¹,

Burd²

2004

Rook's Textbook of Dermatology

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The skin is constantly subjected to both internal and external mechanical forces, so that for experimental purposes it may be impossible to determine what constitutes the normal resting state. These forces are likely to be as important in the maintenance of the structural integrity of the connective tissues of the skin [1,2] as they are with bone, which becomes demineralized during the protracted absence of normal gravitational force during space travel [3]. In contrast to events in the whole organism, isolated human dermal fibroblasts in culture make more collagen when subjected to reduced gravity [4]. Many normal biochemical functions of the skin are dependent on appropri-ate mechanical forces, and when these become excessive, as in lymphoedema, protease inhibitors are released with many deleterious consequences [5].Healthy skin is well adapted to resist the adverse effects of a wide range of mechanical injuries [6]. These include friction, pressure, contusion, laceration, suction and vibration. The clinical consequence of injury will depend on characteristics of the noxious stimulus, such as its intensity and duration. Factors related to the skin also influence the response; thus, the same degree of friction may produce a blister in one person but no visible change in another. Time is required for adaptive responses, such as callus formation and lichenification, to occur.

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Subgaleal Hematoma from Hair Combing

Cited by 43 publications

References 0 publications

Subgaleal Hemorrhage Secondary to Child Physical Abuse in a 4-Year-Old Boy

Subgaleal Hemorrhage Secondary to Child Physical Abuse in a 4-Year-Old Boy

Childhood Subgaleal Hematoma Following Minor Head Trauma

Mechanical and Thermal Injury

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