cranial hematomas

• related: Pediatric

Caput succedaneum

Caput:

• path: subcutaneous, above periosteum, between skin and galea
• pt: pressure against dilating cervix in head first delivery (vertex), after prolonged labor or vacuum assisted delivery
• symptoms
  • extend across midline/sutures
  • poorly defined margins
  • discoloration
  • PE shows boggy region of scalp with pitting edema and ill defined borders that do not expand over time
  • usually serous fluid but can have blood
• treatment: resolves over the first few days. Observe

Cephalhematoma

Cephalohematoma:

• path/pt: subperiosteum hematoma (rupture of blood vessels between skull and periosteum) caused by surgical trauma or can be vacuum/forceps. Most common parietal
• symptoms
  • bulging head
  • jaundice, hyperbilirubin from hemolysis
  • rare: anemia, hypotension
  • Do not cross suture lines. well demarcated
  • Can calcify or ossify leading to skull deformation
• treatment: observe. Resolve in weeks to months

Subgaleal

Subgaleal

• path: bleed between galea aponeurosis and periosteum
• pt: vacuum apply to head in delivery.
• symptoms
  • crosses midline
  • rapid expansion of swelling can be fatal due to shock and massive blood loss
• treatment:
  • ICU monitor with fluid replacement and CBC/coagulation study