Subaponeurotic fluid collections are a rare cause of head swelling in young neonates. They are thought to be due to birth trauma from assisted delivery, e.g. prolonged assisted delivery or ventouse delivery, with associated microfistula development that leads to CSF leakage.
Delayed subaponeurotic fluid collections manifest as a benign CSF fluid under the galea aponeurotica (subgaleal) spontaneously between 1 month 4 months of age, which is thought to be the delayed result of a traumatic labor and delivery.4
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Clinical presentation
Clinical findings include a soft, fluctuant, compressible scalp mass that crosses suture lines. It is benign and often resolves spontaneously. This is clinically important as head swelling can be extensively over-investigated. Ultrasound is useful for diagnosis.
Imaging
Subaponeurotic fluid collections are subgaleal collections that can cross sutures and midline (see subgaleal hematoma).
Treatment and prognosis
Subaponeurotic fluid collections are normally conservatively treated and usually resolve spontaneously. Aspiration is usually not required.
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