Cephalohematoma

• Etiology:
  — Complication of difficult vaginal delivery and more common with instrumented delivery
  — Subperiosteal hemorrhage due to skull being scraped along ischial spines
• Imaging:
  — Deepest scalp hematoma lying between skull and pericranium that does not cross suture lines because it is bound by the periosteum
  — Contains blood
  — Can calcify over time
  — Most commonly parietal
  — Rarely see fractures
• Imaging CT:
  — Initially can appear as scalloping lesion as it begins to calcify and differential diagnosis is aggressive bone lesion or dermoid or epidermoid
  — Later develops peripheral calcification varying in thickness
  — Finally has appearance of expanded diploic space and may be confused with fibrous dysplasia – look for internal matrix to distinguish from fibrous dysplasia
• Note: Epidural hematoma and cephalohematoma are mirror images in that epidural hematoma occurs inside skull and is bound by the dura and does not cross sutures and cepahlohematoma occurs outside skull and is bound by periosteum and does not cross sutures
• DDX:
  — Cephalohematoma is deepest scalp hematoma lying between skull and pericranium, does not cross suture lines
  — Subgaleal hematoma is middle scalp hematoma lying between pericranium and epicranial aponeurosis, does cross suture lines
  — Caput succadaneum is most superficial scalp fluid collection lying between epicranial aponeurosis and skin, does cross suture lines
• Complications: Often become inconspicuous as child grows but may require cosmetic surgery
• Treatment: Usually spontaneous resorbed over first month of life
• Clinical: Larger hematomas may present as calvarian masses as they calcify and remodel

Radiology Cases of Cephalohematoma