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Delayed Neonatal Scalp Swelling: A Rare Case of Subaponeurotic Fluid Collection
A 7-week-old infant presented with 2 weeks of progressive scalp swelling. The patient was born at 41 weeks via a vacuum-assisted cesarean section delivery. The swelling was not present at birth. On examination, the patient had a fluctuant area of swelling near the crown of the head which crossed suture lines. No findings of trauma were identified on examination. Head CT showed no signs of intracranial hemorrhage or skull fracture but did note an extradural collection that crossed sutures lines ([Fig. 1] and [Fig. 2]). MRI confirmed an extracalvarial fluid collection [Fig. 3].
With a lack of trauma identified on history or imaging, a diagnosis of delayed subaponeurotic fluid collection (DSFC) was made. DSFC is a rare and benign cause of scalp swelling in the neonate. In a case report of 11 neonates with DSFC all patients had a history of vacuum-assisted delivery with no swelling reported at birth. A review of 62 cases of DSFC reported spontaneous resolution of swelling within 2 to 24 weeks, supporting conservative management. The etiology is not well understood. Diagnostic aspirations of subaponeurotic fluid collections have revealed cerebrospinal fluid, supporting the notion that the collections are a result of microfractures from birth trauma causing slow and progressive swelling.
Received: 01 July 2022
Accepted: 16 August 2022
Accepted Manuscript online:
17 August 2022
Article published online:
21 December 2022
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- 1 Smith A, Kandamany N, Okafor I, Robinson I, Foran A, McNamara R. Delayed infant subaponeurotic (subgaleal) fluid collections: a case series of 11 infants. J Emerg Med 2016; 50 (06) 881-886
- 2 Faried A, Imron A, Aliyannissa A, Indrawati D. Delayed subaponeurotic fluid collection on an infant's head: underreported case and review of the literature. Surg Neurol Int 2021; 12: 233
- 3 Schoberer A, Yagmur E, Boltshauser E, Korinth M, Niggemann P, Häusler M. Sub-aponeurotic fluid collections: a delayed-onset self-limiting cerebrospinal fluid fistula in young infants. Eur J Paediatr Neurol 2008; 12 (05) 401-403