Aims To raise awareness of potential different causes of subgaleal haematoma in a child.
Method We report the case of an 8 month old boy who presented with an unexplained fluctuating scalp swelling in the left parietal region. CT scan revealed a subgaleal haematoma. A literature review (PubMed) suggests that while subgaleal haematoma is a common neonatal problem particularly following instrumental delivery, it is rarer in the paediatric age group. It is associated with underlying coagulation disorders, vascular malformations, accidental head trauma and abusive head trauma.
Results The boy presented to his GP and was subsequently referred to paediatricians with a left sided fluctuant scalp swelling, first noticed by parents 3 days before presentation. There was no witnessed trauma but he was mobile, cruising and crawling around with ease. Parents reported the swelling was increasing in size. He was haemodynamically stable with normal neurology. A differential diagnosis of abusive head trauma was made and he was admitted to the paediatric ward for a child protection medical examination and a strategy meeting. MRI brain showed a left parietal subgaleal haematoma with no underlying skull fracture. Skeletal survey, ophthalmology examination and MRA were all normal. Metabolic screen and coagulation were normal. Haemoglobin was 10.0 and did not drop throughout admission. The final diagnosis was one of accidental injury, likely due to an unwitnessed fall. After a strategy meeting he was discharged home. He was reviewed on the ward 5 days later and the swelling had completely resolved. The parents found the process extremely stressful and were reluctant to cooperate with medical professionals.
Conclusions We highlight the need to be aware that a child presenting with a subgaleal haematoma can be confused with non accidental injury and the importance of considering all possible diagnoses.
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