Differential Diagnosis for a 1-day-old Boy with a Firm, Well-Demarcated Swelling on the Right Parietal Scalp
- Single Most Likely Diagnosis
- Cephalohematoma: This condition is characterized by a firm, well-demarcated swelling on the scalp, often resulting from birth trauma, such as a forceps-assisted delivery. The absence of discoloration or tenderness and the specific location on the parietal scalp support this diagnosis.
- Other Likely Diagnoses
- Subgaleal Hemorrhage: Although less likely due to the well-demarcated nature of the swelling, subgaleal hemorrhage can occur after birth trauma and presents as a scalp swelling. However, it typically crosses suture lines and may be more diffuse.
- Caput Succedaneum: This is a common condition after vaginal delivery, presenting as a soft, puffy swelling of the scalp. However, it usually involves the presenting part of the scalp and may not be as well-demarcated as described.
- Do Not Miss Diagnoses
- Skull Fracture: Although the swelling is described as firm and well-demarcated without tenderness, a skull fracture could potentially present similarly, especially if it occurred during the forceps-assisted delivery. Missing this diagnosis could have significant implications for the infant's care and outcome.
- Osteomyelitis or Infection: While less likely given the acute presentation and context of a recent birth, any scalp swelling in a neonate warrants consideration of infection, particularly if there are signs of systemic illness or if the swelling does not resolve as expected.
- Rare Diagnoses
- Dermoid Cyst: A congenital anomaly that could present as a firm swelling on the scalp. However, these are typically present at birth and may have associated findings such as a sinus tract or other skin anomalies.
- Encephalocele: A rare congenital defect where brain tissue and meninges herniate through a defect in the skull. This would be an unusual presentation for an encephalocele, but it could potentially mimic a scalp swelling if small and covered by skin.