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July 1992

Radiological Cases of the Month

Author Affiliations

From the Departments of Pediatrics (Dr Levkoff) and Radiology (Dr Macpherson), Medical University of South Carolina, Charleston.

Am J Dis Child. 1992;146(7):833-834. doi:10.1001/archpedi.1992.02160190065021

Four infants delivered after full-term pregnancies presented with large, diffuse, fluctuant swelling of the scalp, which was diagnosed as cephalohematoma in three and as severe caput in one. All infants had signs of hypovolemia at birth; one infant died of irreversible shock. Obstetrical instrumentation was used at birth for all infants. Figure 1 shows a computed tomogram of patient 1, and Fig 2, clinical appearance of patients 2 and 3.

Denouement and Discussion 

Unrecognized Subaponeurotic Hemorrhage  At birth, the infrequent, but potentially disastrous, subaponeurotic hemorrhage may go undiagnosed. When present, this epicranial injury may be confused with the more common cephalohematoma or caput succedaneum.In each infant, a fluctuant scalp swelling that crossed suture lines was described on initial physical examination immediately after delivery. Nevertheless, neither the volume of the swelling nor its subaponeurotic location was appreciated. Instead, a diagnosis of a large caput was made in one infant and

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