From the Research
An ultrasound is typically not needed for a simple, uncomplicated cephalohematoma. Cephalohematomas are subperiosteal hemorrhages that occur between the skull bone and periosteum, usually resulting from birth trauma or minor head injuries. They can be diagnosed through clinical examination, appearing as a soft, fluctuant swelling that does not cross suture lines of the skull. Most cephalohematomas resolve spontaneously within weeks to months without specific treatment. However, ultrasound may be indicated in certain circumstances: if the cephalohematoma is unusually large, shows signs of infection, fails to resolve over time, or if there are concerns about underlying skull fractures or other complications. In these cases, ultrasound can help evaluate the extent of the hematoma, detect calcifications, or identify potential complications, as noted in a case report where point-of-care ultrasound was used to distinguish between a subgaleal hematoma and a cephalohematoma 1. The decision to perform imaging should be based on the clinical presentation, the child's age, the mechanism of injury, and the presence of any concerning symptoms such as excessive irritability, fever, or increasing size of the swelling. For routine, uncomplicated cephalohematomas in otherwise healthy infants, clinical observation alone is sufficient management.
Some key points to consider in the management of cephalohematomas include:
- Clinical examination is usually sufficient for diagnosis
- Ultrasound may be useful in certain cases, such as distinguishing between a subgaleal hematoma and a cephalohematoma 1
- Aspiration may be necessary if infection is suspected, as noted in a review of infected cephalohematomas 2
- Most cephalohematomas resolve spontaneously, but some may ossify and present as a hard scalp swelling, as described in a case report of an ossified cephalohematoma 3
- Rarely, cephalohematomas can become infected, and may require drainage and antibiotics, as noted in a case report of a spontaneously infected cephalohematoma 4.
In general, the management of cephalohematomas should be guided by the clinical presentation and the presence of any concerning symptoms, with ultrasound and other imaging modalities used judiciously to evaluate the extent of the hematoma and detect potential complications. According to the most recent and highest quality study, ultrasound is not typically needed for routine, uncomplicated cephalohematomas 1.