2025 Poster Presentations
P203: SPONTANEOUS SUBAPONEUROTIC FLUID COLLECTION IN AN INFANT
Ali A Mohamed, MS1; Leana Pinas-Zade, BS2; Emma Sargent, BS1; Paul Christakis, MD1; Brandon Lucke-Wold, MD, PhD3; 1Charles E. Schmidt College of Medicine, Florida Atlantic University; 2College of Medicine, Florida State University; 3Lillian S. Wells Department of Neurosurgery, University of Florida
Background: Spontaneous subaponeurotic fluid collections (SSFCs) are benign and usually self-limiting fluid collections beneath the aponeurosis of the scalp. The abrupt onset and unusual appearance of SSFCs may cause significant alarm and suspicion of considerable pathology or child abuse. With unclear etiology and concerning clinical presentation, it is important to recognize SSFCs as a unique condition separate from those that may require more immediate neurosurgical intervention. Herein, we present a 10-week-old male infant with an occipitoparietal fluid collection, identified as a SSFC, following a prolonged vaginal delivery, which resolved spontaneously within 24 hours.
Case Presentation: A 10-week-old male presents with a scalp swelling/fluid collection in the left lateral occipitoparietal region (Figure 1; red arrow). The fluid collection was soft diffuse, nontender, fluctuant, with fluid thrill, and not limited by suture lines or presenting with associated bruising or erythema. He was delivered vaginally following 6 hours of hard labor and was monitored with a fetal scalp electrode. No swelling or abnormal fluid collections, injury, trauma, or hair manipulation was noted in the scalp from the immediate neonatal period until the current presentation. This fluid collection was subsequently identified as a spontaneous subaponeurotic fluid collection (SSFC). An ultrasound was scheduled as an initial diagnostic step, but the SSFC resolved spontaneously within 24 hours.
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Discussion: Given that SSFCs do not clearly fall into the category of a known pathology but share characteristics with other conditions, unnecessary workup or concern may result. This is because their mixed presentation can be alarming, potentially sharing the rare complications of known pathologies such as elevated intracranial pressure, calcification, and infection that typically warrant neurosurgical intervention and further evaluation. A primary distinction between SSFCs and other conditions such as subgaleal hematomas, cephalohematomas, or caput succedaneum is the time of onset. The conditions are typically present at birth but SSFCs typically appear several weeks postpartum and are likely due to cerebrospinal fluid (CSF) leakage rather than hemorrhage. SSFCs typically manifests in neonates and infants under 12 months of age as soft, non-tender, mobile swellings that are not confined by suture lines.
There have been reports of traumatic or instrumented delivery as potential precipitating factors. Wang et al. reported that 8 out of 9 infants with SSFCs had experienced complicated deliveries, including the use of forceps or vacuum assistance. Additionally, Petraglia et al. found that the use of fetal scalp electrodes during labor may also contribute to the formation of SSFCs. However, a more recent report by Abusaleem et al. reported a SSFC in a male delivered by cesarean section at 39 weeks with no preceding attempts of vaginal delivery, instrumental assistance, or placement of scalp electrodes during delivery.
Conclusion: Despite their benign and transient nature, SSFCs may raise suspicions of child abuse or more severe conditions requiring more immediate neurosurgical intervention. Although the exact pathophysiology and etiology of SSFCs remain unclear, SSFCs typically resolve spontaneously with no additional diagnostic workup or management necessary following adequate differentiation from other conditions.