Astrid Sarvis MD, Children’s National Medical Center

The Case
A 10do M presents with scalp swelling and a sparse history, raising concern for non-accidental trauma.

Here’s How You Answered Our Questions:

The “other” answers were a plain film of the skull as the imaging study of choice, and obtaining birth records/calling the birth hospital as a next step in management.

Denouement:
Given the patient’s presentation in the absence of known birth trauma or other explanation, there was concern for possible NAT. The team was also concerned that if the patient had a subgaleal hemorrhage, it could expand. A head CT and skeletal survey were ordered. Head CT showed small likely subgaleal hemorrhages (vs cephalohematoma) of scalp and skeletal survey was negative. Mom later spoke to dad to clarify, at which time dad reported he had noticed the scalp swelling a few days ago, and had the PMD evaluate the patient 3 days ago which mom was unaware of. We were able to contact the PMD prior to discharge, and they expressed no concerns with the family or child. Given that the patient had a normal hemoglobin and there were no other concerns for trauma or inflicted injury, the patient was discharged home without social work or Child Protective Services involvement.

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