Presentation
Scalp wound with purulent discharge, 1 week after head trauma.
Patient Data
Bifrontal-biparietal-bitemporal-occipital subgaleal abscess (i.e. thick fluid measuring ~30 HU with enhancing borders) with maximum thickness of 10 mm, draining through an opening in the right parietal scalp.
CT head-neck trauma done 1 week earlier (neck not included):
Subcutaneous parieto-occipital scalp contusion, hint of broken skin in parietal scalp right of midline.
Case Discussion
History of minor head trauma one week earlier, sustained a 1 cm superficial scalp laceration without active bleeding. Presented to the ED after falling and injuring her hip. Hip fracture ruled out. Blood work was remarkable for leukocytosis of ~30K with 90% neutrophils and a CRP of 450 mg/dL. A scalp wound with purulent discharge was seen. CT head showed an extensive scalp empyema. Treated with clindamycin and ceftriaxone IV to cover group A Streptococcus (GAS). The collection was partially drained. Pus culture yielded Strep. pyogenes.
Subgaleal abscess is a rare complication of either head trauma or sinusitis (secondary subgaleal abscess) and can also arise de novo (primary subgaleal abscess).
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