Exploring the Depths: A Case Report of a Record-Breaking Subgaleal Hematoma Uncovered

Abstract

This case report highlights an unusual manifestation of a giant subgaleal hematoma in a 15-year-old child, which progressed to a potentially life-threatening condition requiring surgical drainage. Subgaleal hematomas occur when the emissary veins between the periosteal and aponeurotic layers of the scalp rupture. In many cases, subgaleal hematomas undergo spontaneous absorption without intervention. However, in this particular case, the hematoma measured approximately 1300 ml, making it the largest documented in medical literature and necessitating surgical intervention. In cases where hematoma absorption is problematic, clinicians should consider the possibility of underlying coagulopathy or persistent trauma, such as head banging, child maltreatment, or repeated falls due to seizure attacks, as observed in this patient. While there is no universally agreed-upon treatment protocol for subgaleal hematomas, incision and drainage offer immediate relief by evacuating the collection. Employing a negative-pressure suction drain can help alleviate the loss of tamponade effect. In addition, subsequent behavioral therapy and rehabilitation efforts may enhance the overall recovery and well-being of affected individuals.

Keywords: cephalohematoma; emergency medicine; largest subgaleal hematoma; neurosurgery; pediatric surgery; subgaleal hematoma; vascularsurgery.

Figure 1. Clinical photograph of the patient at the time of presentation showing large softy tissue swelling of the entire scalp with a head circumference of 96 cm

Figure 2. Clinical photograph of the patient with bilateral proptosis more pronounced on the left side

Figure 3. Non-contrast computed tomography, sagittal sections showing the extracalvarial collection of approximately 1300 cc in the frontoparietal region, as shown by the blue arrow

Figure 4. Non-contrast computed tomography coronal section showing the large subgaleal hematoma in the bilateral frontoparietal region, as shown by the blue arrow

Figure 5. Computed tomography showing minimal residual hematoma in the extracalvarial space with a negative suction drain