Bilateral cephalhematomas in a juvenile--case report.

A 14-year-old boy presented with subperiosteal cephalhematomas in bilateral parietotemporal sites after a minor head injury. Magnetic resonance (MR) imaging showed that one of the hematomas had progressed beyond suture lines, and spread under the temporal muscle layer. Progressive enlargement of the cephalhematomas occurred despite medical and needle aspiration treatment. Surgery found that the hematoma had separated the periosteum from the skull bone surface, and the periosteum had lost the tight attachment to the suture lines. Continuous suction-drainage reduced the size of the hematomas without complications. MR imaging can identify subperiosteal cephalhematomas. The relationship of the hematoma and the temporal muscle may be the key MR imaging finding for the diagnosis of cephalhematoma. We suggest that some juvenile cephalhematomas may be a different clinical entity from those occurring in neonates.