Cephalohematoma Case File

https://medical-phd.blogspot.com/2021/03/cephalohematoma-case-file.html

Eugene C. Toy, MD, Lawrence M. Ross, MD, PhD, Han Zhang, MD, Cristo Papasakelariou, MD,
FACOG

Case 43
A male infant who weighs 3500 g appears icteric on examination. The previous day, the infant was
delivered vaginally by vacuum-assisted extraction because there were severe fetal heart rate
decelerations. The infant’s scalp has a 5-cm discolored soft tissue swelling that seems to be
contained by and does not cross the sagittal or lambdoidal sutures. The mother had no prenatal or
medical problems. There is no family history of bleeding disorders.

⯈ What is the most likely diagnosis?

⯈ What is the anatomical mechanism for the condition?

ANSWER TO CASE 43:

Cephalohematoma
Summary: On the previous day, a 3500-g male infant was delivered vaginally by
vacuum-assisted extraction. The infant appears icteric, and his scalp has a 5-cm
hematoma that is contained by and does not cross the sagittal or lambdoidal sutures.

• Most likely diagnosis: Cephalohematoma

• Anatomical mechanism for the condition: Injury to the branches of arteries supplying the
lateral skull

CLINICAL CORRELATION
This 1-day-old infant was delivered with the aid of vacuum extraction and now has icterus and a
discolored soft tissue mass that is contained within the sutures. This almost certainly represents a
cephalohematoma. The more common caput succedaneum, which is swelling of the scalp soft
tissue, is a normal response of the fetal head to the birth process. In this situation, the blood will
cross over suture lines. When a soft tissue mass seems contained by suture lines, subgaleal
cephalohematoma is suspected. The hemoglobin deposited in the hematoma becomes bilirubin,
which is the reason for the infant’s icterus. A skull radiograph or CT scan is usually obtained to
assess for skull fracture. Most of these hematomas will resolve with observation.

APPROACH TO:
The Scalp and Skull

OBJECTIVES
1. Be able to define the layers of the scalp
2. Be able to describe the structure of cranial sutures

DEFINITIONS
MAJOR SUTURES OF THE SKULL: The sagittal suture runs along the midline of the skull
between the two parietal bones. The lambdoidal suture runs left to right posteriorly and separates
the two parietal bones from the occipital bone. The coronal suture has the same course anteriorly
and separates the frontal bone from the two parietal bones.

HEMATOMA: Pool of blood that accumulates in a tissue or space, usually clotted.

BILIRUBIN: Bile salt that is formed from the breakdown of hemoglobin by the liver. It usually
accumulates in the gallbladder and is excreted into the small bowel to facilitate digestion. High
levels of bilirubin in the blood give the skin and sclera of the eyeballs a yellowish tint (jaundice).

ICTERIC: Yellowish appearance of jaundice, in this case due to the local breakdown of bilirubin
in the blood that has accumulated in the hematoma.

CAPUT SUCCEDANEUM: Edematous swelling of the superficial scalp due to the normal trauma
of the birth process that resolves within 2 to 3 days.