1. Neonatal Head Ultrasound: Extracranial Hemorrhage
Jenelle Beadle, RDMS
Inland Imaging
May 2017

2. Scalp Hematomas Subdivided by location (from superficial to deep)
Caput Succedaneum: subcutaneous
Suk-se-day-nee-um
Most common secondary to vacuum assisted delivery
Subgaleal Hematoma: between the galea aponeurosis and periosteum
Cephalohematoma: between the skull & periosteum
Bound by suture lines
Epidural/subdural hemorrhages are beneath the skull and cannot be reliably detected with ultrasound

3. Scalp Hematomas Subdivided by location, BUT
Ultrasound cannot identify the layers of the scalp, so we must generally rely on other features to distinguish one type of hematoma from another

4. Scalp Hematomas Distinguishing Features
Caput Succedaneum: poorly defined; localized soft tissue edema
Maximal size at birth & gradual resolves over hours or days
Vague borders; pitting edema
Subgaleal Hematoma: poorly defined; wide-spread (may extend to orbits)
Presents after birth & progressively worsens; resolves over 2-3wks
Blood volume may be massive (may be associated with coagulopathy)
Associated with skull fracture
Cephalohematoma: well defined; does not cross sutures
Presents after birth & increases for 12-24hrs; resolves over weeks or months
Rarely severe

5. Caput Succedaneum
Caused by pressure of skull against dilating cervix or vacuum assisted delivery
Located at the presenting portion of the skull or vacuum placement site

6. Caput Succedaneum
Caused by pressure of skull against dilating cervix or vacuum assisted delivery
Located at the presenting portion of the skull or vacuum placement site
“cone head”
Vaginal delivery only
Not associated with skull fracture

7. Caput Succedaneum
Caused by pressure of skull against dilating cervix or vacuum assisted delivery
Poorly defined; localized soft tissue edema
pitting

8. Caput Succedaneum
Caused by pressure of skull against dilating cervix or vacuum assisted delivery
Poorly defined; localized soft tissue edema
Maximal size at birth & gradual resolves over hours or days
Ultrasound is typically not ordered/needed

9. Subgaleal Hematoma
Caused by vacuum/forceps assisted delivery or head trauma
Associated with coagulopathy
May occur spontaneously

10. Subgaleal Hematoma
Caused by vacuum/forceps assisted delivery or head trauma
Associated with coagulopathy
May occur spontaneously
Associated with skull fracture

11. Subgaleal Hematoma
Caused by vacuum/forceps assisted delivery or head trauma
Wide-spread
Sub-galeal space covers the entire cranium
From eyes to the nape of the neck
From ear to ear

12. Subgaleal Hematoma
Caused by vacuum/forceps assisted delivery or head trauma
Wide-spread
Not limited by sutures
No barriers to limit bleeding
Blood will shift

13. Subgaleal Hematoma Blood loss may be massive
Usually develop slowly (hours/days)
Mortality reported from 12-25%
Symptoms signify extensive blood loss
Increased circumference
Decreased hematocrit; increased bilirubin
Neurological disturbances (seizures, etc.)

14. Subgaleal Hematoma

15. Subgaleal Hematoma (fracture)

16. Cephalohematoma Caused by vacuum/forceps assisted delivery
Incidence: 1-2% of live births
Increases with instrument delivery

17. Cephalohematoma Caused by vacuum/forceps assisted delivery
Bound by sutures
Usually over the parietal bone(s)
Well defined margins
Firm

18. Cephalohematoma Caused by vacuum/forceps assisted delivery
Bound by sutures
Usually over the parietal bone(s)
Well defined margins
Firm
Cephalohematoma

19. Cephalohematoma Caused by vacuum/forceps assisted delivery
Bound by sutures
Usually over the parietal bone(s)
Well defined margins
Firm

20. Cephalohematoma Caused by vacuum/forceps assisted delivery
Bound by sutures
May calcify

21. Take home message:
Identify relationship of hematoma to sutures