Cephal Hematoma Case Report

European Journal of Radiology Extra 49 (2004) 35–36

Double skull sign of ossified cephalohematoma on CT

Akihiro Uemura∗ , Toshihiro O’uchi, Yoichi Kikuchi
Department of Radiology, Kameda Medical Center, Higashi-cho 929, Kamogawa, Chiba, 296-8602 Japan
Received 8 July 2003; accepted 7 October 2003

Abstract
Cephalohematomas occur during delivery by shearing forces between the skull and pericranium. If they are not absorbed they can ossify
over the surface. We report an interesting computed tomography (CT) finding of ossified cephalohematoma mimicking double skull.
© 2003 Elsevier Ireland Ltd. All rights reserved.
Keywords: Ossification; Cephalohematome; Computed tomography
1. Introduction lifted and the ossification gradually covers over the surface
of the hematoma [1] although there is an exceptional case
Cephalohematomas occur during delivery by shearing which lacks ossification [3].
forces and they are usually absorbed in 1 month. However, Although plain radiograph findings of ossified cephalo-
if they are not absorbed they begin to ossify [1]. We re- hematomas have been discussed in the past [4,5], CT find-
port an interesting computed tomography (CT) finding of ings of early ossified cephalohematomas have not been re-
ossified cephalohematoma mimicking double skull. ported. In our case, CT was performed about a month after
birth. The thick band-like ossification was noted only over
the surface of the hematoma and thought to be characteristic
2. Case report of initial stage of ossification. It mimicked doubling of the
skull and we named the finding “double skull sign” (Fig. 1).
A 34-day-old boy with a history of vacuum extraction was At birth, because of the softness of the cephalohe-
admitted to our hospital with a large, persistent right parietal matoma the clinical diagnosis may be confused with caput
mass after birth. Head CT showed an expansile lesion over succedaneum and encephalocele [4]. The follow up CT
the right parietal bone. The lesion did not cross the coro- obtained 1 month after birth in addition to clinical informa-
nal and lambdoidal sutures and diagnosed as a cephalohe- tion is thought to be useful to make diagnosis of ossified
matoma. The thick and band-like ossification on the lateral
surface had an appearance of “double skull”.
3. Discussion
Cephalohematoma, a collection of blood between the

skull and the pericranium, is caused by lifting of the scalp
from the skull by shearing forces before or during the de-
livery. It occurs especially in cases of vacuum extraction or
forceps delivery [2]. If it is not absorbed within a month,
it can begin to ossify on the place where the periosteum is
Fig. 1. Double skull sign of ossified cephalohematomas on CT obtained
from a 34-day-old boy; A and B. A well-circumscribed and expnasile
∗Corresponding author. Tel.: +81-47-92-2211; fax: +81-47-99-1191. mass in the right parietal bone. Note the band-like ossification over the
E-mail address: [email protected] (A. Uemura). surface mimicking double skull (arrows).
1571-4675/$ – see front matter © 2003 Elsevier Ireland Ltd. All rights reserved.
doi:10.1016/S1571-4675(03)00118-4
36 A. Uemura et al. / European Journal of Radiology Extra 49 (2004) 35–36
cephalohematoma by identifying the thick band-like ossifi- [2] Broekhuizen FF, Washington JM, Johnson F, Hamilton PR. Vac-
cation (double skull sign) which does not cross the cranial uum extraction versus forceps delivery: indications and complications,
1979–1984. Obstet Gynecol 1987;69:338–42.
sutures. [3] Firlik KS, Adelson PD. Large chronic cephalohematoma without cal-
cification. Pediatr Neurosurg 1999;30:39–42.
[4] Harris VJ, Meeks W. The frequency of radiolucencies underlying
References cephalohematomas. Radiology 1978;12:389–91.
[5] Stokes NJ, Cremin BJ. The skull vault in neonates and infants. Aus-
[1] Morgan JE. Calcification in cephalohematomata of the newborn infant. tralas Radiol 1974;18:275–82.
Am J Obestet Gynecol 1944;48:702–5.

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European Journal of Radiology Extra 49 (2004) 35–36

Double skull sign of ossified cephalohematoma on CT

Received 8 July 2003; accepted 7 October 2003

Keywords: Ossification; Cephalohematome; Computed tomography

Cephalohematoma, a collection of blood between the

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