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) 

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.