Pediatric Subgaleal Hematoma

Etiology: Birth trauma or blunt trauma resulting in blood in subgaleal space
Imaging:
— Middle scalp hematoma lying between pericranium and epicranial aponeurosis
— Does cross suture lines
— Contains blood
— Rarely see fractures in birth trauma
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:
Treatment:
Clinical: Lasts for weeks

Radiology Cases of Subgaleal Hematoma

CT of subgaleal hematoma — 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.

Radiograph of stellate skull fracture and CT of acute subdural hematoma due to accidental trauma — AP and lateral radiographs of the skull show numerous branching lucencies in the right parietal bone. Axial CT without contrast of the brain shows high density material in the right subgaleal tissues, a small high density cresenteric fluid collection in the right extra-axial space that extends posteriorly along the falx, and a mixed low-density and high density lesion in the right posterior parietal brain parenchyma.

CT of subgaleal hematoma, diastatic skull fracture, depressed skull fracture, cerebellar contusion, diffuse cerebral edema in child abuse — Axial 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.

CT of caput succedaneum — 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.

Skull radiograph of subgaleal hematoma — 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.

CT of subgaleal hematoma — 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.

CT of cerebellar hemorrhage — 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.