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Massive Subgaleal Hematoma and Clinical Suspicion of Child Abuse

  • Shaheen Shamji and Jeanne L. Jacoby
Published/Copyright: January 1, 2015
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Journal of Osteopathic Medicine
From the journal Journal of Osteopathic Medicine Volume 115 Issue 1

A 2-year-old girl was brought to the emergency department by her mother because of head swelling. Physical examination revealed macrocephaly (head circumference, 64.5 cm [reference range, 44-51 cm]).1 A computed tomographic scan of the head showed a subgaleal hematoma that measured 4.5 cm in the craniocaudal dimension (image A and image B). A radiograph showed a healing fracture of the distal humerus, and bone scan findings revealed occult fractures of the right tibia and wrist. On the basis of these findings, child abuse was suspected. Child protective services was contacted, and its representatives confirmed the clinical suspicion of child abuse. A complete investigation was negative for coagulopathies and hemophilia. Two subgaleal drains were placed, and 1500 mL of serosanguineous fluid was removed. The final diagnosis was nonaccidental trauma by chronic hair traction.

Although subgaleal hematoma after the neonatal period is rare, cases of subgaleal hematoma secondary to vigorous hair combing and braiding,2-6 minor falls,7 and—rarely—child abuse8 have been reported. To our knowledge, 1500 mL is the largest amount of fluid from a subgaleal hematoma reported. Clinicians should be aware of less dramatic presentations. (doi:10.7556/jaoa.2015.014)

Acknowledgment

We acknowledge the following individuals for their editorial assistance: Kevin Weaver, DO, emergency medicine residency director; Nidhi Shah, DO, pediatrics resident; and Bernadette Glenn Porter, BS, CIM, emergency medicine scholarly activity coordinator, all with the Lehigh Valley Health Network.

*Address correspondence to Jeanne L. Jacoby, MD, Emergency Medicine Research, Lehigh Valley Health Network, 1240 S Cedar Crest Blvd, Suite 212, Allentown, PA 18103-6218. E-mail:

References

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2. Yip CC ,McCulleyTJ,KerstenRC,KulwinDR. Proptosis after hair pulling. Ophthal Plast Reconstr Surg. 2003;19(2):154-155.10.1097/01.IOP.0000055828.10127.70Search in Google Scholar PubMed

3. Falvo CE ,San FilippoJA,VartanyA,OsbornEH. Subgaleal hematoma from hair combing.Pediatrics.1981;68(4):583-584.10.1542/peds.68.4.583Search in Google Scholar

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7. Kuban K ,WinstonK,BresnanM. Childhood subgaleal hematoma following minor head trauma. Am J Dis Child. 1983;137(7):637-640.10.1001/archpedi.1983.02140330021006Search in Google Scholar PubMed

8. Seifert D ,PuschelK. Subgaleal hematoma in child abuse [published online September 26, 2005]. Forensic Sci Int. 2006;157(2-3):131-133.10.1016/j.forsciint.2005.03.023Search in Google Scholar PubMed

Received: 2014-07-14
Accepted: 2014-07-31
Published Online: 2015-01-01
Published in Print: 2015-01-01

© 2015 American Osteopathic Association

This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

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  3. LETTERS TO THE EDITOR
  4. The Journal of the American Osteopathic Association
  5. Gray Zone: Why a Delayed Acceptance of Osteopathic Medicine Persists in the International Community
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  7. Identification of Musculoskeletal Disorders in Medically Underserved Regions of South America and Vietnam
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  9. The Emerging Use of Platelet-Rich Plasma in Musculoskeletal Medicine
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  11. Use of a Novel Assay to Measure Pre-to Posttraining Palpatory Skills of First-Year Osteopathic Medical Students
  12. SPECIAL COMMUNICATION
  13. Mastering the Art of Abstracts
  14. CASE REPORT
  15. Resolution of Hypothyroidism After Correction of Somatovisceral Reflex Dysfunction by Refusion of the Cervical Spine
  16. THE SOMATIC CONNECTION
  17. The Somatic Connection
  18. Osteopathic Manipulative Treatment Is Effective for Nonspecific Low Back Pain
  19. Spinal Manipulation Improves Pain Perception, Spinal Mobility, and Height in Men With Degenerative Disk Disease
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  23. CLINICAL IMAGES
  24. Massive Subgaleal Hematoma and Clinical Suspicion of Child Abuse
https://doi.org/10.7556/jaoa.2015.014
Creative Commons
BY-NC-ND 4.0

Articles in the same Issue

  1. SURF
  2. Ode to DO Students
  3. LETTERS TO THE EDITOR
  4. The Journal of the American Osteopathic Association
  5. Gray Zone: Why a Delayed Acceptance of Osteopathic Medicine Persists in the International Community
  6. ORIGINAL CONTRIBUTION
  7. Identification of Musculoskeletal Disorders in Medically Underserved Regions of South America and Vietnam
  8. REVIEW
  9. The Emerging Use of Platelet-Rich Plasma in Musculoskeletal Medicine
  10. MEDICAL EDUCATION
  11. Use of a Novel Assay to Measure Pre-to Posttraining Palpatory Skills of First-Year Osteopathic Medical Students
  12. SPECIAL COMMUNICATION
  13. Mastering the Art of Abstracts
  14. CASE REPORT
  15. Resolution of Hypothyroidism After Correction of Somatovisceral Reflex Dysfunction by Refusion of the Cervical Spine
  16. THE SOMATIC CONNECTION
  17. The Somatic Connection
  18. Osteopathic Manipulative Treatment Is Effective for Nonspecific Low Back Pain
  19. Spinal Manipulation Improves Pain Perception, Spinal Mobility, and Height in Men With Degenerative Disk Disease
  20. Osteopathic Manipulative Treatment Improves Clinical Response and Lowers Relapse Rates Among Patients With Chronic Low Back Pain
  21. Are Some of Us Doomed to Have Chronic Low Back Pain?
  22. Spinal Manipulation and Home Exercises Are Effective for Subacute and Chronic Back-Related Leg Pain
  23. CLINICAL IMAGES
  24. Massive Subgaleal Hematoma and Clinical Suspicion of Child Abuse
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