subgaleal hematoma

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


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.



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


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

Radiographic features

  • blood of moderate echogenicity
  • decreasing echogenicity with time
  • not bound by periosteum
  • 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

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