Baby boy with bump on head.

Our appreciation is extended to Dr. Louis Moore, Indiana University Department of Radiology, for contributing this case.

Baby boy with bump on head.

Baby boy with bump on head.

Differential diagnosis: 

• Cephalohematoma
• Parietal bone fracture with overlying hematoma
• Subgaleal hematoma
• Caput succedaneum
• Encephalocele
• Vascular malformation
• Malignancy (sarcoma, metastatic neuroblastoma)
• Infection/osteomyelitis

Baby boy with bump on head.

Key points:

• Cephalohematoma is a traumatic subperiosteal hemorrhage due to rupture of blood vessels between the skull and the periosteum, and it is confined by cranial sutures. They are thought to result from birth trauma, with risk factors including prolonged and difficult deliveries. They usually increase in size after birth.
• On physical exam, a firm, tense mass may be palpable. On CT or MR imaging, these typically appear as crescent-shaped lesions adjacent to the outer table of the calvarium, confined by cranial sutures and possibly calcified. MR signal intensity is dependent on age of the blood products.
• Patients with cephalohematoma are typically managed conservatively. They can occasionally become infected, possibly requiring antibiotics and/or I&D. These typically resolve over months with skull growth and bony remodeling; prolonged resorption can lead to calcification.

References:

1. Morón F, et al. Lumps and bumps on the head in children: use of CT and MR imaging in solving the clinical diagnostic dilemma. Radiographics. 2004 Nov-Dec;24(6):1655-74.
2. Ingram, MD and Hamilton, WM. Cephalohematoma in the Newborn. Radiology. October 1950 Radiology, 55, 503-507.

Baby boy with bump on head.