Extracranial Hematomas

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Subgaleal hematomas fill the large potential space between the galea and periosteum. In neonates and infants, up to 250 cc of blood (a life-threatening hemorrhage) can accumulate in the subgaleal space, and are not restricted to the suture sites. Subgaleal hematoma commonly results from birth injury. Hematocrit should be followed closely and transfusions given if needed. Surgical evacuation is rarely indicated. Needle drainage should be avoided because of the potential for infection. Most lesions spontaneously resolve.

Subperiosteal hematomas (equivalent to 'cephalhematomas') are limited in extent by sutural attachments of the periosteum to the outer table of the skull. They may result from birth or other trauma and are commonly associated with a linear

Figure 6. Calcified cephalhematoma. Axial computed tomography demonstrates a calcified, subperiosteal mass in the right parietal region. Formation of a cephalohematoma in this location had been noted at birth.

skull fracture. In the presence of a fracture, communication with an associated epidural hematoma indicates the potential for sudden neurological deterioration due to mass effect. Surgical drainage is indicated only for related problems (e.g., associated epi-dural hematoma, depressed skull fracture). Occasionally, subperiosteal hematomas calcify and require late surgical intervention for cosmetic reasons (see Fig. 6).

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