Original articleSub-aponeurotic fluid collections: A delayed-onset self-limiting cerebrospinal fluid fistula in young infants
Introduction
Skull masses in young infants show a heterogeneous etiology, including congenital (dermoid, epidermoid cyst, encephalocele, lipoma, lymphangioma, naevus), traumatic (sub-aponeurotic hemorrhage (SH), subcutaneous caput succedaneum, subperiostal cephalhematoma), neoplastic (teratoma, neuroblastoma) and vascular (arterial and venous malformation) lesions.1, 2, 3, 4 Whereas most lesions are well described, the etiology of sub-aponeurotic fluid collections (SFC), a disorder recently specified by Hopkins et al., has remained uncertain.5 Like SH, these soft, non-tender and fluctuating swellings may be linked to birth trauma, for example, ventouse-assisted delivery. SFC, however, do not contain large amounts of blood, are not present from birth but develop within few weeks of life. A minor form of SH, disruption of scalp lymphatic drainage and cerebrospinal fluid (CSF) leakage are discussed as etiological factors.5
Section snippets
Patient reports
Five previously healthy children developed occipital fluctuating and painless soft tissue swellings without skin reddening 7 (n=1) and 8 weeks (n=4) after birth, respectively.
Four of the lesions were of large size, one patient showed just a small lesion. Patients 1, 3 and 5 had been delivered by vacuum extraction. In patient 2 cesarean section was performed when external cephalic version failed repeatedly, in patient 4 when vacuum extraction had failed twice and a loud “bang” was noticed. In
Laboratory findings
All aspirates had a serosanguineous appearance (Table 1). Whereas microbiological studies proved normal, the CSF markers β-trace protein (βTP; immunofixation analysis) and β2-transferrin (immunonephelometry) were found in all aspirates (Fig. 2). β2-Transferrin is physiological only in CSF, aqueous humor and perilymph fluid. βTP (Prostaglandin D synthase) represents about 3% of total CSF protein, showing levels that are approximately 35 times higher than in serum.7 Therefore, for example, the
Discussion
Whereas isolated patients with lesions resembling SFC have repeatedly been reported in the literature, the characteristics of this lesion have been delineated only recently by Hopkins et al., summarizing the clinical findings of seven patients.5 Six of these patients had developed SFC between 3.5 and 18 weeks after birth, four of them had been delivered by vacuum extraction. In one patient, microbiological analysis of an aspirate proved normal. In all reported cases, SFC disappeared after 2–24
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Delayed infant subaponeurotic (subgaleal) fluid collection
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2016, Journal of Emergency MedicineCitation Excerpt :They proposed that disruption of emissary or diploic veins, which connect intracranial dural sinuses to superficial scalp veins, or microfractures undetectable by imaging may explain the origin of the CSF leaking into the subaponeurotic fluid collections. Interestingly, both Schoberer et al., who reported that fluid was aspirated in three cases, and Chalipat et al., who aspirated one case, state that fluid re-accumulation occurred after aspiration in all cases (5,7). This suggests that aspiration of the fluid is not helpful in the diagnosis or management of this condition and should be avoided as it carries the potential risk of introducing infection.
Sub-aponeurotic fluid collection in a neonate associated with fetal scalp electrode monitoring: A brief communication
2014, European Journal of Obstetrics and Gynecology and Reproductive BiologyDelayed Neonatal Scalp Swelling: A Rare Case of Subaponeurotic Fluid Collection
2023, NeuropediatricsA rare combination of findings mimicking inflicted head trauma: A case of spontaneous subaponeurotic fluid collection overlying accessory sutures
2022, Journal of Paediatrics and Child Health