Cephalhematoma

Cephalhematoma

A cephalhematoma is a type of hematoma that occurs in the periosteum of an infant's skull bone. It is a collection of blood between the skull bone and its periosteum, typically resulting from birth trauma. Cephalhematomas are most commonly associated with the use of forceps or vacuum extraction during delivery, but they can also occur in spontaneous vaginal deliveries.

Pathophysiology

Cephalhematomas occur when blood vessels rupture during the birthing process, leading to a collection of blood beneath the periosteum. The periosteum is a dense layer of vascular connective tissue enveloping the bones except at the surfaces of the joints. Because the periosteum is tightly adhered to the skull bones, the hematoma is confined to the surface of one cranial bone and does not cross suture lines. This is a key distinguishing feature from other types of neonatal head injuries, such as caput succedaneum, which can cross suture lines.

Clinical Presentation

Cephalhematomas typically present as a soft, fluctuant swelling on the infant's head. The swelling is usually unilateral and confined to one cranial bone, most commonly the parietal bone. The overlying skin is usually not discolored, and the swelling may not be apparent immediately after birth, often becoming more noticeable in the first few days of life as the hematoma enlarges.

Diagnosis

Diagnosis of cephalhematoma is primarily clinical, based on the characteristic presentation and physical examination. Imaging studies, such as ultrasound or CT scan, are rarely needed but can be used to confirm the diagnosis or rule out other conditions if there is uncertainty.

Management

Most cephalhematomas resolve spontaneously without intervention over a period of weeks to months. The body gradually reabsorbs the blood, and the swelling diminishes. In rare cases, complications such as jaundice or anemia may occur due to the breakdown of red blood cells within the hematoma. In such cases, medical management may be necessary.

Complications

While cephalhematomas are generally benign, potential complications include:

• Jaundice: As the blood in the hematoma breaks down, bilirubin levels may rise, leading to jaundice.
• Anemia: Significant blood loss into the hematoma can lead to anemia.
• Infection: Although rare, infection of the hematoma can occur.
• Calcification: In some cases, the hematoma may calcify, leading to a bony prominence.

Also see

• Caput succedaneum
• Subgaleal hemorrhage
• Neonatal jaundice
• Birth trauma

Pediatric glossary of terms | Glossary of medical terms | Dictionary of pediatrics