Unexpected bilateral cranial swellings in a neonate

A 9-day-old male child born to a 24-year-old mother with three previous healthy children (one boy and two girls) was admitted with gradually increasing swellings over both parietal regions (figure 1), which was noticed on day 3 of life. He was a full-term normal vaginal delivery after an uneventful antenatal period, weighing 2.5 kg. The cutting of the umbilical cord was not associated with excessive bleeding. Vitamin K had been given intramuscularly at birth. A physical examination revealed a haemodynamically stable but pale baby with bilaterally symmetrically soft, fluctuant swellings measuring 3.5–4 cm in diameter over the parietal scalp regions. The rest of the examination was within normal limits. There was no evidence of bleeding from any other site or family history of bleeding tendencies. Figure 1 Bilateral cephalohaematoma. How do you differentiate between the diagnoses below? 1. Caput succedaneum 2. Subgaleal haemorrhage 3. Cephalohaematoma 4. Subgaleal cerebrospinal fluid (CSF) collection C. Cephalohaematoma. Caput succedaneum is a boggy, diffuse subcutaneous scalp swelling that has poorly defined margins and can extend over the suture lines. It is usually associated with moulding of head. A subgaleal bleed is a massive fluctuant swelling, and can extend from the orbital ridges to the nape of the neck. It is …