How Is Subcutaneous Hematoma On The Head Treated ?

Posted on Tue, 8 May 2012

Question: My 4 year old son bumped his forehead 4 weeks ago with terrible force. He was rushed to Emergency to be checked out for concussion and was fine. He developed a large black lump on his forehead and over the weeks this has subdued. 2 nights ago I noticed a prominant lump that appears to be growing on his temple. I took him the Dr. today and she recommended an xray saying it is a hematoma that has travelled from his forehead. I cannot get him into a radiology clinic for a few days. Do I need to worry about this travelling near any major arteries or veins being in the temple aread? Should I take him straight to Emergency again? I am worried about it travelling a few millimeters more and putting pressure on vital arteries in and around his temple and therefore brain.

Answered by Dr. Dr. Prasad J (49 minutes later)

Dear XXXXXXX

'Sub cutaneous hematoma' is not serious concern. They usually resolve in a few days.

Major blood vessels supplying the brain are located in the neck (Internal carotid arteries) and in the neck (vertebral arteries) beneath the subcutaneous plane. It is very, very unlikely that subcutaneous hematoma will cause obstruction of these major arteries. "So it will not affect the brain."

I agree with your doctor here. The lump could be hematoma and Xray's will be useful.

Observe and watch out for severe headache, recurrent vomiting, drowsiness, loss of consciousness, convulsions and so on. Immediate medical attention at ER is necessary if the aforementioned symptoms develop. Else go ahead as planned now.

Hope you find my answers useful and reassuring. I am available to answer your follow up queries.

Wish your son healthy and speedy recovery.

Regards

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Dr. Prasad J (32 minutes later)

Thank you for your response. You say the major vessels supplying the brain are in the neck. I was specifically worried about the middle meningeal artery at the temple and pressure on this.

Answered by Dr. Dr. Prasad J (32 minutes later)

Hi,

Thanks again.

Intracranial arteries and brain are safely protected within the skull. I agree with you - middle meningeal artery is closely related to the temple, intracranially. But the current lump - subcutaneous hematoma refers to the collection of blood beneath the skin and NOT intracranial.

So the pressure caused by subcutaneous hematoma is very, very unlikely to be transmitted across the hard bone to the middle meningeal artery.

Pressure on the intracranial arteries occur in the following circumstances:
1. Large intracranial hematoma
2. Large depressed skull fractures with intracranial bleeding
3. Space occupying lesions such as tumours, cysts and so on; located in proximity to the arteries.

Your descriptions aren't suggestive of any of the above condition. So you need not concern.

Warning symptoms that I suggested in my previous mail are features suggesting a serious concern and that needs immediate attention.

If you feel my answers were adequate and reassuring, I request you to accept it.

Wish your son speedy recovery!!

Regards

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Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar