Infected Subgaleal Hematoma Following Blunt Head Trauma in a Child: Case Report and Review of the Literature

Abstract

Subgaleal hematoma (SGH), an uncommon but potentially dangerous complication, has been reported to occur with delivery in newborns, as well as in young patients following head trauma. Infection of a SGH is extremely rare, especially in cases where no disruption of the skin barrier occurs. We report a case of an infected SGH in an 8-month-old following closed skull fracture. The patient presented with scalp swelling 1 day after falling 3 feet. Initial evaluation found a nondisplaced skull fracture on computed tomography. She was discharged following an uneventful 23-hour observation. Three days later, she developed symptoms concerning for a viral upper respiratory tract infection and received symptomatic treatment. Nine days after injury, she returned with continued fevers, irritability, and significant increase in scalp swelling. Magnetic resonance imaging showed a subgaleal abscess with osteomyelitis. Needle aspiration revealed an infected hematoma with cultures positive for Streptococcus pneumoniae, treated with intravenous ampicillin. Purulent drainage from an enlarging necrotic needle aspiration site required subsequent surgical debridement of the subgaleal abscess with drain placement. She recovered well following surgery and intravenous antibiotics. Physicians should be aware that SGH carries a risk of serious morbidity and mortality. SGH can serve as a nidus for infection, typically from skin barrier breakdown or, as in this case, hematogenous spread. Early recognition, appropriate antibiotic therapy, and surgical debridement are critical in treating infected SGH.

Rare cause of scalp swelling in an infant

“…Subgaleal abscess is a rare complication of sinusitis, bacteraemia, trauma or scalp infection 1–4 . Pus collects between the periosteum of the skull and the epicranial aponeurosis following either haematogenous seeding of bacteria, or direct extension from an adjacent infection, the probable mechanism in this case.…”

Traumatic subgaleal hematoma drainage in an adolescent: a case report and review of the literature

“…Infection of subgaleal hematomas secondary to a scalp laceration during instrumented delivery has been well described in the neonatal period ( 1 ). In older children, subgaleal hematomas can also get infected through local spread of bacteria, but hematogenous dissemination during an upper respiratory infection has also been reported: Barry et al report a healthy 8-month-old girl who presented with an infected subgaleal hematoma following a minor fall.…”

“…Subgaleal hematomas occurs when blood accumulates between the periosteum and the aponeurosis due to the tearing of emissary veins. It is a known complication of instrumentation at birth, and neonates can have up to 50% of the body blood volume accumulate in the space, leading to hemorrhagic shock and death ( 1 , 2 ). Even though most cases of subgaleal hematomas occur in the neonatal period, older children and adults are also at-risk following head trauma.…”

Subgaleal haematoma due to hair pulling: Review of the literature

“…In older children, SGH has been reported as the presenting sign in several coagulopathies and anatomic variants, and leukaemia . Two cases of infected haematoma unrelated to birth trauma have been reported, both from haematogenous seeding . Ocular complications can include proptosis that can result in corneal abrasion or compartment syndrome and can be vision threatening …”