Subgaleal hematoma evacuation in a pediatric patient: A case report and review of the literature

Abstract

Background: Subgaleal hematoma (SGH) is generally documented within the neonatal period and is rarely reported as a result of trauma or hair braiding in children. While rare, complications of SGH can result in ophthalmoplegia, proptosis, visual deficit, and corneal ulceration secondary to hematoma extension into the orbit. Although conservative treatment is preferential, expanding SGH should be aspirated to reduce complications associated with further expansion. Case Description: A 12-year-old African-American female with no recent history of trauma presented with a chief complaint of headache along with a 2-day history of enlarging 2–3 cm ballotable bilateral frontal mass. Hematological workup was negative. The patient’s family confirmed a long history of hair braiding. The patient was initially prescribed a period of observation but returned 1-week later with enlarging SGH, necessitating surgical aspiration. Conclusion: SGH is rare past the neonatal period, but can be found in pediatric and adolescent patients secondary to trauma or hair pulling. Standard workup includes evaluation of the patient’s hematological profile for bleeding or coagulation deficits, as well as evaluation for child abuse. Although most cases of SGH resolve spontaneously over the course of several weeks, close follow-up is recommended. The authors present a case of a 12-year-old female presenting with enlarging subgaleal hemorrhages who underwent surgical aspiration and drainage without recurrence. A literature review was also conducted with 32 pediatric cases identified, 20 of which were related to hair pulling, combing, or braiding. We review the clinical course, imaging characteristics, surgical management, as well as a review of the literature involving subgaleal hemorrhage in pediatric patients and hair pulling.

Hematoma subgaleal espontáneo en lactantes, una enfermedad subestimada, serie de casos

“…Estas son lesiones microscópicas que, por la laxitud de la gálea y una vasculatura relativamente más abundante en estos niños, facilitan el sangrado espontáneo o posterior a un traumatismo ocurrido varios días atrás. Este último caso es una asociación discutible y se propone como hipótesis (5).…”

“…En niños mayores de 6 meses, los casos suelen estar asociados con traumatismos mayores o menores (incluyendo maltrato), malformaciones vasculares o tumores (1,5). La aparición espontánea (sin dato de traumatismo), posterior a traumatismos triviales, o tardía con respecto al momento del trauma debe llamar la atención sobre la posibilidad de una discrasia sanguínea (6).…”