A neonate with a firm, fluctuant mass over the cranial bone that does not cross suture lines should be evaluated for which associated injury?

• A. Cephalohematoma
• B. Caput succedaneum
• C. Subgaleal hemorrhage
• D. Linear skull fracture

Answer: (D)

The main idea is that the pattern of scalp swelling in a newborn helps identify the underlying structure involved and what other injuries to look for. A firm, well‑circumscribed lump that stays on a single bone and does not cross the suture lines points to a cephalohematoma, which is a subperiosteal hematoma beneath the periosteum. Birth trauma causes rupture of vessels between the skull bone and periosteum, so the collection is confined by the periosteum and won’t cross sutures. Because cephalohematomas can be associated with an underlying skull fracture from birth trauma, you should evaluate for a skull fracture—most commonly a linear skull fracture. Imaging such as skull radiographs or cranial ultrasound can help detect a fracture in a neonate, with CT reserved for concern for intracranial injury or if neurologic signs appear. In contrast, caput succedaneum spreads across sutures as diffuse capillary edema, and a subgaleal hemorrhage can extend over the scalp and cross sutures, which is why the crossing pattern helps distinguish these conditions.