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Clinical Images  |   January 2015
Massive Subgaleal Hematoma and Clinical Suspicion of Child Abuse
Author Affiliations & Notes
  • Shaheen Shamji, DO
    From the Department of Emergency Medicine at the Lehigh Valley Health Network in Allentown, Pennsylvania.
  • Jeanne L. Jacoby, MD
    From the Department of Emergency Medicine at the Lehigh Valley Health Network in Allentown, Pennsylvania.
  •  *Address correspondence to Jeanne L. Jacoby, MD, Emergency Medicine Research, Lehigh Valley Health Network, 1240 S Cedar Crest Blvd, Suite 212, Allentown, PA 18103-6218. E-mail: jeannejacoby38@yahoo.com
     
Article Information
Emergency Medicine / Imaging / Pediatrics / Clinical Images
Clinical Images   |   January 2015
Massive Subgaleal Hematoma and Clinical Suspicion of Child Abuse
The Journal of the American Osteopathic Association, January 2015, Vol. 115, 58. doi:10.7556/jaoa.2015.014
The Journal of the American Osteopathic Association, January 2015, Vol. 115, 58. doi:10.7556/jaoa.2015.014
A 2-year-old girl was brought to the emergency department by her mother because of head swelling. Physical examination revealed macrocephaly (head circumference, 64.5 cm [reference range, 44-51 cm]).1 A computed tomographic scan of the head showed a subgaleal hematoma that measured 4.5 cm in the craniocaudal dimension (image A and image B). A radiograph showed a healing fracture of the distal humerus, and bone scan findings revealed occult fractures of the right tibia and wrist. On the basis of these findings, child abuse was suspected. Child protective services was contacted, and its representatives confirmed the clinical suspicion of child abuse. A complete investigation was negative for coagulopathies and hemophilia. Two subgaleal drains were placed, and 1500 mL of serosanguineous fluid was removed. The final diagnosis was nonaccidental trauma by chronic hair traction. 
Although subgaleal hematoma after the neonatal period is rare, cases of subgaleal hematoma secondary to vigorous hair combing and braiding,2-6 minor falls,7 and—rarely—child abuse8 have been reported. To our knowledge, 1500 mL is the largest amount of fluid from a subgaleal hematoma reported. Clinicians should be aware of less dramatic presentations. (doi:10.7556/jaoa.2015.014) 
Acknowledgment
We acknowledge the following individuals for their editorial assistance: Kevin Weaver, DO, emergency medicine residency director; Nidhi Shah, DO, pediatrics resident; and Bernadette Glenn Porter, BS, CIM, emergency medicine scholarly activity coordinator, all with the Lehigh Valley Health Network.  
References
Data table of infant head circumference-for-age charts. US Centers for Disease Control and Prevention website. http://www.cdc.gov/growthcharts/html_charts/hcageinf.htm. Accessed November 24, 2014.
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