From the Research
No, an ultrasound is typically not necessary to confirm the diagnosis of caput succedaneum versus cephalohematoma. These conditions can usually be distinguished through careful physical examination by a healthcare provider. Caput succedaneum presents as diffuse, soft swelling that crosses suture lines of the skull and typically resolves within a few days after birth without treatment. In contrast, a cephalohematoma is a firmer swelling that does not cross suture lines, contains blood between the skull bone and its periosteum, and may take weeks to months to resolve. The key distinguishing features are the boundaries of the swelling (crossing suture lines or not) and the consistency of the swelling (soft and pitting in caput versus firmer in cephalohematoma).
Imaging studies like ultrasound would be considered only in atypical presentations, when there is concern for underlying skull fracture, or when the diagnosis remains uncertain after physical examination, as suggested by a recent study 1. This approach is practical because both conditions are generally benign and self-limiting, though cephalohematomas require longer monitoring for complications such as jaundice due to breakdown of blood cells. The use of point-of-care ultrasound (POCUS) has been described to help differentiate between subgaleal hematoma and cephalohematoma 1, but this does not directly apply to the differentiation between caput succedaneum and cephalohematoma.
Some studies have highlighted the importance of not misdiagnosing caput succedaneum as more serious conditions like cephalocele 2, but these are distinct clinical entities. The clinical presentation and physical examination findings are usually sufficient to diagnose caput succedaneum and cephalohematoma, making ultrasound unnecessary in most cases.
Key points to consider in the diagnosis include:
- The presence of diffuse, soft swelling that crosses suture lines in caput succedaneum
- The presence of a firmer swelling that does not cross suture lines in cephalohematoma
- The typical resolution of caput succedaneum within a few days without treatment
- The potential for cephalohematoma to take weeks to months to resolve and the need for monitoring for complications like jaundice.
Given the most recent and highest quality evidence available, ultrasound is not typically necessary for the diagnosis of caput succedaneum versus cephalohematoma, and a careful physical examination by a healthcare provider is usually sufficient 1.