Purpose or Case Report: Illustrate radiological manifestations and clinical course from benign to severe subgaleal processes, highlighting the crucial role of advanced imaging in diagnosis, management, and outcome prediction.
Methods & Materials:
We retrospectively included infants presenting with subgaleal processes who underwent radiologic evaluation via CT, doppler ultrasound or MRI. Two pediatric radiologists evaluated all imaging and descriptive analysis was used to demonstrate the prevalence of specific imaging features including atypical course and novel features. For each case, data such as clinical presentation, imaging modality, management approach, and outcomes were collected.
Results:
Three patients met inclusion and exclusion criteria. The mean age at time of diagnosis was 2 months. In a more benign example of a subgaleal process, a three-month-old male’s mother noticed a new area of fluctuance over the patient’s occipital region. An aseptic subaponeurotic fluid collection manifested as a new occipital fluctuance, visualized on ultrasound imaging as a ballotable anechoic fluid accumulation beneath the galea aponeurotica that spontaneously resolved by the infant’s four-month well-child examination.
A more acute case involved a three-month-old infant who presented to the ER with a palpable fluctuant parietal scalp mass with diffuse calvarial erythema and 30 mL of spontaneous purulent drainage during ultrasound imaging. MRI images characterized the lesion as a subgaleal hemorrhage evolving into a spontaneous decompression of subgaleal abscess. In the most severe case, a term neonate who underwent forceps delivery and extensive birth trauma requiring cooling and a two month NICU stay presented with caput succedaneum on day of life one which became diffuse scalp swelling. This was further thought to be cephalohematoma. The infant was ultimately diagnosed with complete posterior calvarial scalp necrosis demonstrated by CT. Silver nitrate paste covering the entire calvarium prevented follow-up MRI imaging due to ferromagnetic effects of silver heating.
Conclusions:
Subgaleal processes of the infant cranium are an important spectrum of findings with overlapping imaging features and possibly significant clinical implications. Early imaging and accurate differentiation between these pathologies is critical in prevention of complications and guiding multidisciplinary management. Having a strong foundation of the clinical and imaging findings of each can serve as an important tool in the radiologist’s toolbelt.