subgaleal hematoma

Diagram of
the infant scalp showing the locations of the common hematomata of the scalp in relation the layers of the scalp. Newborn Scalp Hematomata
Wikipedia • CC-BY-SA-3.0
Extradural
hemorrhage • Extradural hematoma, subdural hematomas, cerebral contusions and subgaleal hematoma - Ganzer Fall bei Radiopaedia
Gaillard, F. Extradural hematoma, subdural hematomas, cerebral contusions and subgaleal hematoma. Case study, Radiopaedia.org. (accessed on 20 Oct 2022) https://doi.org/10.53347/rID-19252 • CC by-nc-sa 3.0 (modified)
Infant
dropped by parent. Axial CT without contrast of the brain shows a left parietal depressed skull fracture with high density material in the adjacent subgaleal space that crosses sutures and courses around to the right side of the skull.The diagnosis was a depressed skull fracture causing a subgaleal hematoma.
pediatricimaging.org • CC-by-nc-sa 4.0
Toddler who
is unresponsiveAxial CT without contrast of the brain shows high density material in the subgaleal tissues posteriorly, a wide lucency in the right posterior skull along with two areas of depressed lucency in the left frontal skull, a rounded high-density lesion in the midline of the cerebellum, and decreased density of the cerebrum when compared to the normal density of the cerebellum along with loss of the normal gray matter-white matter differentiation.The diagnosis was a posterior subgaleal hematoma, a right posterior diastatic skull fracture and a left frontal depressed skull fracture, cerebellar contusion and diffuse cerebral edema in a child abuse patient.
pediatricimaging.org • CC-by-nc-sa 4.0
Newborn with
failure to progress during delivery due to dystocia who is now apneic. Axial CT without contrast of the brain shows a cresenteric high-density fluid collection in the subcutaneous tissues of the right scalp that crosses suture lines and a cresenteric low-density fluid collection in the subcutaneous tissues of the left scalp that crosses suture lines. Intracranially, there is diffuse loss of gray matter-white matter differentiation secondary to diffuse cerebral edema.The diagnosis was a left caput succedaneum and a right subgaleal hematoma in a patient with hypoxic ischemic encephalopathy.
pediatricimaging.org • CC-by-nc-sa 4.0
Newborn with
scalp swelling and bruising and decreased hemoglobin after a delivery by C-section for failure to descend. AP and lateral radiographs of the skull show diffuse soft tissue swelling of the scalp that crosses sutures and that is especially prominent over the left fronto-parietal region.The diagnosis was subgaleal hematoma.
pediatricimaging.org • CC-by-nc-sa 4.0
School ager
hit in head by a golf ball. Axial CT without contrast of the brain shows a high density fluid collection in the left frontal subcutaneous tissue. There is also an underlying lentiform mixed density intracranial fluid collection.The diagnosis was a left frontal subgaleal hematoma with an underlying epidural hematoma.
pediatricimaging.org • CC-by-nc-sa 4.0
Subarachnoid
hemorrhage • Traumatic subarachnoid hemorrhage - coup-contrecoup injury - Ganzer Fall bei Radiopaedia
Knipe, H. Traumatic subarachnoid hemorrhage - coup-contrecoup injury. Case study, Radiopaedia.org. (accessed on 22 Oct 2022) https://doi.org/10.53347/rID-33934 • CC by-nc-sa 3.0 (modified)
Newborn who
underwent vacuum extraction during a difficult delivery. Axial (left) and coronal (right) CT without contrast of the brain shows a small, round, dense lesion in the left cerebellar hemisphere. The coronal image also shows a dense fluid collection in the left superior subcutaneous tissues of the skull which crosses the sagittal suture in the midline.The diagnosis was left cerebellar hemorrhage and left subgaleal hematoma.
pediatricimaging.org • CC-by-nc-sa 4.0
Radiopaedia • CC-by-nc-sa 3.0 • de

Subgaleal hematoma describes scalp bleeding in the potential space between the periosteum and the galea aponeurosis. It is a rare but possibly lethal emergency.

Epidemiology

Moderate to severe presentations occur in 1.5 of 10,000 live births. It most commonly occurs after vacuum-assisted and forceps delivery, but may also be seen following head trauma or occur spontaneously. In patients with intracranial hemorrhage or skull fractures, the incidence of subgaleal hemorrhage is increased.

Clinical presentation

Signs include pallor on inspection. On examination, there may be tachycardia, hypotonia. A fluctuant scalp mass with increasing head circumference may be seen on palpation.

Pathology

Etiology

Bleeding occurs as a result of rupture to emissary veins which drain the scalp veins into the dural sinuses.

Location

Due to being superficial to the periosteum, subgaleal hematomas are able to cross suture lines and canvas the entire skull.

Radiographic features

Ultrasound
  • blood of moderate echogenicity
  • decreasing echogenicity with time
  • not bound by periosteum
CT
  • more objective measurement of hematoma volume
  • determine presence of an underlying skull fracture

Radiology report

  • size of the hematoma
  • content of the fluid collection
  • presence of an associated fracture

Differential diagnosis

General imaging differential considerations include:

On certain MRI sequences also consider:

See also

Siehe auch:
und weiter:
Assoziationen und Differentialdiagnosen zu subgaleal hemorrhage:
Galeahämatom
 
Wikipedia • CC-BY-SA-3.0
Geburtsgeschwulst
 
Wikipedia • CC-BY-SA-3.0
Kephalhämatom
 
pediatricimaging.org • CC-by-nc-sa 4.0
SCALP
mnemonic
Wikipedia • CC-BY-SA-3.0
Geburtstraumata
 
pediatricimaging.org • CC-by-nc-sa 4.0