Delayed subaponeurotic fluid collection of infancy

Abstract

The unexplained appearance of a boggy scalp swelling in an infant can prompt concerns of non-accidental injury. We report a case of delayed subaponeurotic fluid collection of infancy; a benign condition with no clear aetiology. Recognition may prevent over-investigation of child protection concerns.

Delayed subaponeurotic fluid collection on an infant’s head: Underreported case and review of the literature

“…All 16 articles were reviewed by the first author and data were then extracted). ere were 15 cases reported from the United States of America, [5,7,9,14] 12 cases from the United Kingdom, [4,6,10,15] 11 cases from Ireland, [12] 9 cases from Canada, [16] 5 cases from Germany, [11] 5 cases from Turkey, [13] 2 cases from India, [2,8] and 1 case each from Australia, [13] the Netherland, [1] and Indonesia (this report) shown in [Table 1]. Overall, mean of age when DSFCs were diagnosed was 8.2 ± 3.7 weeks, ranges from 2 to 18 weeks.…”

“…Overall, mean of age when DSFCs were diagnosed was 8.2 ± 3.7 weeks, ranges from 2 to 18 weeks. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16] Mean resolution of scalp swelling was 7.4 ± 5.4 weeks, ranges from 2 to 24 weeks. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16] Since its rarity and limited cases reported around the world, many physicians never seen DSFCs before and may not recognize its clinical entity in the first place; Worthen et al published article concerning rare scalp mass that identified through a disease-specific blog, analyzing experiences of 69 families whose infants developed DSFCs.…”

“…[1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16] Mean resolution of scalp swelling was 7.4 ± 5.4 weeks, ranges from 2 to 24 weeks. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16] Since its rarity and limited cases reported around the world, many physicians never seen DSFCs before and may not recognize its clinical entity in the first place; Worthen et al published article concerning rare scalp mass that identified through a disease-specific blog, analyzing experiences of 69 families whose infants developed DSFCs. [17] Hopkins et al reported the first six cases of DSFCs that managed conservatively and one case was managed by a needle aspiration of the collection on two occasions when serosanguinous fluid was aspirated ×2 after diagnosis.…”

“…[2,3,6,8,10,11] e tapping is not always advocated and many authors even advise against tapping these collections. [1,4,5,7,9,[12][13][14][15][16] Aspiration itself does not resolve the fluid collection, since its nature as self-resolving lesion; not mention that there is a small risk of introducing infection and bleeding. From our own experience and the literatures, we not recommend needle aspiration for future cases.…”

“…Ultrasonography imaging demonstrates a mobile hypodense anechoic fluid collections beneath the hypoechoic aponeurosis without the presence of cyst wall and crossed sagittal suture lines, internal solid component or active flow signals on color Doppler, and no evidence of skull fracture. [1,3,4,8,9,[11][12][13][14]16] While the natural history of DSFCs is benign, its presence can be emotionally draining for the parents; as well as for the physicians not familiar with this rare condition.…”