Subgaleal hematoma (SGH), an uncommon but potentially dangerous complication, has been reported to occur with delivery in newborns, as well as in young patients following head trauma. Infection of a SGH is extremely rare, especially in cases where no disruption of the skin barrier occurs. We report a case of an infected SGH in an 8-month-old following closed skull fracture. The patient presented with scalp swelling 1 day after falling 3 feet. Initial evaluation found a nondisplaced skull fracture on computed tomography. She was discharged following an uneventful 23-hour observation. Three days later, she developed symptoms concerning for a viral upper respiratory tract infection and received symptomatic treatment. Nine days after injury, she returned with continued fevers, irritability, and significant increase in scalp swelling. Magnetic resonance imaging showed a subgaleal abscess with osteomyelitis. Needle aspiration revealed an infected hematoma with cultures positive for Streptococcus pneumoniae, treated with intravenous ampicillin. Purulent drainage from an enlarging necrotic needle aspiration site required subsequent surgical debridement of the subgaleal abscess with drain placement. She recovered well following surgery and intravenous antibiotics. Physicians should be aware that SGH carries a risk of serious morbidity and mortality. SGH can serve as a nidus for infection, typically from skin barrier breakdown or, as in this case, hematogenous spread. Early recognition, appropriate antibiotic therapy, and surgical debridement are critical in treating infected SGH.

1.
Davis DJ: Neonatal subgaleal hemorrhage: diagnosis and management. CMAJ 2001;164:1452-1453.
2.
Gebremariam A: Subgaleal haemorrhage: risk factors and neurological and developmental outcome in survivors. Ann Trop Paediatr 1999;19:45-50.
3.
Kirkpatrick JS, Gower DJ, Chauvenet A, Kelly DL Jr: Subgaleal hematoma in a child, without skull fracture. Dev Med Child Neurol 1986;28:511-514.
4.
Adeloye A, Odeku EL: Subgaleal hematoma in head injuries. Int Surg 1975;60:263-265.
5.
Plauche WC: Subgaleal hematoma. A complication of instrumental delivery. JAMA 1980;244:1597-1598.
6.
Chen CH, Hsieh WS, Tsao PN, Chou HC: Neonatal subgaleal abscess. Eur J Pediatr 2004;163:565-566.
7.
Sisson TR, Lund CJ, Whalen LE, Telek A: The blood volume of infants. I. The full-term infant in the first year of life. J Pediatr 1959;55:163-179.
8.
Beauchamp CJ, Metcalf MB: Subgaleal hemorrhage. Pediatrics 1983;72:912-913.
9.
Kuban K, Winston K, Bresnan M: Childhood subgaleal hematoma following minor head trauma. Am J Dis Child 1983;137:637-640.
10.
Wiley JF 2nd, Sugarman JM, Bell LM: Subgaleal abscess: an unusual presentation. Ann Emerg Med 1989;18:785-787.
11.
Pollack S, Kassis I, Soudack M, Sprecher H, Sujov P, Guilburd JN, et al: Infected subgaleal hematoma in a neonate. Pediatr Infect Dis J 2007;26:757-759.
12.
Robinson RJ, Rossiter MA: Massive subaponeurotic haemorrhage in babies of African origin. Arch Dis Child 1968;43:684-687.
13.
Amar AP, Aryan HE, Meltzer HS, Levy ML: Neonatal subgaleal hematoma causing brain compression: report of two cases and review of the literature. Neurosurgery 2003;52:1470-1474; discussion 4.
14.
Eliachar E, Bret AJ, Bardiaux M, Tassy R, Pheulpin J, Schneider M: Cranial subcutaneous hematoma in the newborn (in French). Arch Fr Pédiatr 1963;20:1105-1111.
15.
Govaert P, Vanhaesebrouck P, De Praeter C, Moens K, Leroy J: Vacuum extraction, bone injury and neonatal subgaleal bleeding. Eur J Pediatr 1992;151:532-535.
16.
Smith SA, Jett PL, Jacobson SL, Binder ND, Kuforiji TA, Gilhooly JT, et al: Subgaleal hematoma: the need for increased awareness of risk. J Fam Pract 1995;41:569-574.
17.
Falvo CE, San Filippo JA, Vartany A, Osborn EH: Subgaleal hematoma from hair combing. Pediatrics 1981;68:583-584.
18.
Ahuja GL, Willoughby ML, Kerr MM, Hutchison JH: Massive subaponeurotic haemorrhage in infants born by vacuum extraction. BMJ 1969;3:743-745.
19.
Hall SL: Simultaneous occurrence of intracranial and subgaleal hemorrhages complicating vacuum extraction delivery. J Perinatol 1992;12:185-187.
20.
Okafor BC: Bilateral otorrhagia and orbital hematoma complicating subgaleal hematoma. Ann Otol Rhinol Laryngol 1984;93:237-239.
21.
Kozinn PJ, Ritz ND, Moss AH, Kaufman A: Massive hemorrhage - scalps of newborn infants. Am J Dis Child 1964;108:413-417.
22.
Eggink BH, Richardson CJ, Rowen JL: Gardnerella vaginalis-infected scalp hematoma associated with electronic fetal monitoring. Pediatr Infect Dis J 2004;23:276-278.
23.
Goodman SJ, Cahan L, Chow AW: Subgaleal abscess: a preventable complication of scalp trauma. West J Med 1977;127:169-172.
24.
Granick MS, Conklin W, Ramasastry S, Talamo TS: Devastating scalp infections. Am J Emerg Med 1986;4:136-140.
25.
Slap F, Jeurissen A, Van Havenbergh T, Deckers F, Marien P, Van Mol C: Late onset subgaleal hemorrhage infection with Streptococcus pneumoniae? Eur J Pediatr 2009;168:647-650.
26.
Ogunrinde G, Ogala W, Ameh E, Onalo R, Lukong C: Subgaleal abscess in the newborn: a case report. Ann Pediatr Surg 2006;2:48-49.
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.