Photoclinic: Cephalhematoma

A male neonate was born at 39 weeks' gestation by vertex vaginal delivery with focal swelling of the head. Vacuum extraction and forceps were not necessary for delivery. The mother had no complications during labor. Apgar scores were 7 and 9 at 1 and 5 minutes, respectively. A cephalhematoma was suspected when the fluctuant parietal swelling did not transilluminate.

Christian A. Sonnefeld, MD, and Atiya Khan, MD, of Morgantown, WVa, also considered caput succedaneum, subgaleal hematoma, leptomeningeal cyst, and encephalocele in the differential diagnosis. Anteroposterior and lateral radiographs of the skull confirmed the diagnosis of cephalhematoma without underlying fracture.

Cephalhematomas are usually located in the parietal region and typically do not mature until the second or third day of the infant's life. These hemorrhages are subperiosteal and do not extend beyond suture lines. An underlying skull fracture can be found in 5% to 25% of patients.¹

Transillumination can assist in the diagnosis. Caput succedaneums and leptomeningeal cysts transilluminate--cephalhematomas and encephaloceles do not. Encephalocele is usually midline-occipital. A caput succedaneum is a benign finding. Rarely, it can be associated with a cephalhematoma secondary to bleeding under the outer periosteum of the bone.²

No treatment is indicated for a cephalhematoma. Surgical drainage or aspiration is contraindicated because of the risk of a complicating infection. Other complications of surgery or aspirationcan include abscess formation and osteomyelitis, although these are rare. Cephalhematomas may be associated with an increased risk of neonatal jaundice and hyperkalemia caused by the breakdown of red blood cells in the blood.³ Therefore, affected infants should be monitored for jaundice. In addition, the hematoma can become calcified. Ossification can produce a skull deformity; however, this rarely requires treatment.⁴

This infant's hematoma resolved spontaneously without intervention or complication.

References:

REFERENCES:

1. Oski FA, DeAngelis C, Feigin RD, Warshaw JB, eds.

Principles and Practice of Pediatrics.

Philadelphia: JB Lippincott Co; 1990:278, 1864.
2. Golomb MR, Cvijanovich NZ, Ferriero DM. Neonatal brain injury. In: Swaiman KF, Ashwal S, Ferriero DM, eds.

Pediatric Neurology: Principles and Practice.

4th ed. St Louis: CV Mosby; 2006:335.
3. Kirimi E, Tuncer O, Atas B, Arslan S. Hyperkalemia most likely associated with massive cephalhematoma in a newborn infant who was treated with urgent peritoneal dialysis: case report.

J Emerg Med.

2003;24:277-279.
4. Chung HY, Chung JY, Lee DG, et al. Surgical treatment of ossified cephalhematoma.

J Craniofac Surg.

2004;15:774-779.