Differential Diagnosis for a 3-year-old with a Frontal "Goose Egg" from Hitting Head off Another Head
- Single most likely diagnosis:
- Closed head injury with a scalp hematoma: This is the most likely diagnosis given the mechanism of injury (hitting head off another head) and the presentation of a "goose egg," which is a common term for a scalp hematoma. The scalp is richly vascularized, and trauma to this area can easily cause bleeding into the soft tissues, leading to swelling.
- Other Likely diagnoses:
- Concussion: Given the mechanism of injury, there's a possibility that the child might have suffered a concussion, especially if there was significant impact. Concussions are a type of traumatic brain injury caused by a blow to the head or body, a fall, or another injury that jars or shakes the brain inside the skull.
- Laceration or abrasion: Depending on the nature of the collision, the child might also have sustained a laceration or abrasion, which would need to be cleaned and possibly sutured.
- Do Not Miss diagnoses:
- Skull fracture: Although less common, a skull fracture is a critical diagnosis not to miss. The presence of a skull fracture can increase the risk of other serious complications, such as epidural or subdural hematomas.
- Epidural or subdural hematoma: These are collections of blood that can occur between the skull and the brain. They are medical emergencies that require immediate attention. Symptoms might not always be immediate and can include severe headache, vomiting, lethargy, and in severe cases, loss of consciousness.
- Intracranial hemorrhage: Any form of bleeding within the brain itself is a life-threatening condition that requires immediate medical intervention.
- Rare diagnoses:
- Depressed skull fracture: This is a type of fracture where fragments of the skull are pushed below the normal surface of the skull. It's less common in the context of a "goose egg" but could occur depending on the specifics of the injury.
- Leptomeningeal cyst: This is a very rare condition that could potentially occur after a head injury, where there is a tear in the dura mater leading to a cyst formation. It's extremely uncommon and usually presents with a soft, pulsatile mass.