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Findings: Serial axial CT images were obtained through the brain at 5 mm intervals without the use of intravenous contrast. Examination of all the images demonstrates multiple focal areas of scalp swelling, this is consistent with the birth process. In addition, bilateral sutural overlap is identified without evidence of skull fracture. The gray white matter differentiation remains intact. Interhemispheric subdural increased attenuation is identified along the interhemispheric fissure. Additionally, relatively low attenuation is identified within the superior sagittal sinus. This area of low attenuation is felt to represent normal attenuation of the superior sagittal sinus relative to the area of increased attenuation that has already been described above.
Diagnosis: Small subdural interhemispheric hemorrhage posteriorly.
Discussion: Subdural hemorrhage is more frequently found in the full-term infant than in the premature infant and is usually related to birth trauma. The usual associations are with forceps delivery or vacuum extraction. An adjacent fracture may be present. When these subdural hematomas are large, associated findings may include flattening of the gyri as well as effacement of the ventricles. On sonography, moderate to large convexity hematomas are typically easy to identify, however, small hematomas may be more difficult to recognize because of the inability to angle the transducer adequately to visualize the brain convexities. Acute hemorrhage in the subdural space appears echogenic on ultrasound. As the hemorrhage evolves, it will become more hypoechoic.
Other hemorrhages associated with trauma during labor and delivery include caput succedaneum, subgaleal hemorrhage, and cephalohematoma. In isolation, these forms of extracranial hemorrhage are benign.
References:
Siegel MJ. Pediatric Sonography, 2nd Edition. 1994:50-51.
Dahnert W. Radiology Review Manual, 3rd Edition. 1996-242.
Kirks D. Practical Pediatric Imaging, 3rd Edition. 1998:144-146.
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