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Subgaleal hematoma in child abuse
1Institut für Rechtsmedizin, Universitätsklinikum Hamburg-Eppendorf, Department of Legal Medicine, University Hospital Hamburg-Eppendorf, Butenfeld 34, 22529 Hamburg, Germany.
Forensic Science International
|September 30, 2005
Summary
A child presented with forehead swelling and bruising, later diagnosed as a subgaleal hematoma. This "scalping" injury resulted from blunt head trauma, specifically forceful hair pulling.
Area of Science:
- Pediatric Radiology
- Forensic Pediatrics
Background:
- Subgaleal hematomas are rare in children and often associated with significant trauma.
- The clinical presentation can be misleading, delaying diagnosis.
Observation:
- A 3.5-year-old boy presented with forehead swelling and ecchymosis, with no clear explanation provided.
- Clinical examination revealed a doughy swelling on the forehead and skull, followed by bilateral periorbital hematomas.
- Radiographs were inconclusive, but ultrasound identified an extensive subgaleal hematoma.
Findings:
- The extensive subgaleal hematoma was diagnosed as "scalping," a sign of significant blunt head trauma.
- The injury mechanism involved shear forces, consistent with forceful hair pulling.
Implications:
- This case highlights the importance of considering non-accidental trauma in pediatric patients with unexplained head injuries.
- Ultrasound is a valuable tool for diagnosing subgaleal hematomas when radiographs are unrevealing.
- Recognizing "scalping" injuries is crucial for forensic investigations and child protection.