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Fibrodysplasia ossificans progressiva (FOP) is an extremely rare connective tissue disease, diagnosed by genetic testing. This is the first report in English literature wherein an ultrasound examination suggested this specific diagnosis. In this case, a two month old girl presented with bi-parieto-occipital swellings that were being managed as subgaleal haematoma. The parents were anxious that there was no resolution of the swellings. The suspicion of FOP was raised during the ultrasound examination where a review of the images prompted a questioning of the parents about other lesions in the body. Ultrasound examination of a lump in the thigh revealed calcifications in the vastus lateralis muscle. The appearances on the ultrasound combined with the presence of hallucis valgi suggested a diagnosis of FOP. The diagnosis was subsequently confirmed by genetic studies. This case highlights the need for good communication between the physician, patient and the imaging department.

The scalp is anatomically described as having five layers: Skin, SubCutaneous tissue, Aponeurosis, Loose areolar tissue and Pericranium (SCALP-a well known and useful acronym). Functionally however this can be considered as two layers—a deeper layer of pericranium and areolar tissue (which is attached to the skull), upon which sits a mobile superficial layer comprised of skin, subcutaneous tissue and the galea aponeurotica. It is between these two layers that the scalp moves and blood can collect—a scalp or subgaleal haematoma. Most scalp lacerations extend the full thickness of the upper layer.

BACKGROUND: Sickle cell disease is a genetic condition frequently found in Africa and the Arabian Peninsula. Uncommon complications include subgaleal haematoma (soft head syndrome) and periorbital oedema. CASE PRESENTATION: A 17-year-old male patient presented with body aches and progressive right parieto-temporal and frontal head swelling. Physical examination revealed puffiness of the right eye that progressed rapidly to reddish periorbital oedema sparing the extraocular muscle and pupil response to light. CT and MRI of the brain suggested multiple subgaleal haematomas (soft head syndrome) and right periorbital oedema. CONCLUSION: Subgaleal haematoma (soft head syndrome) and periorbital oedema are uncommon complications of sickle cell disease. Management is conservative rather than surgical. LEARNING POINTS: Subgaleal haematoma concurrently with periorbital oedema is a rare presentation of sickle cell disease. There are no guidelines on treatment, but the conditions in our patient resolved with conservative management.

Subgaleal haematoma in adulthood and periorbital necrotising fasciitis are unusual occurrences that have not been reported together. We discuss the first observed case of a 35-year-old female with periorbital necrotising fasciitis postulated to be caused by subgaleal haematoma following head trauma that was successfully managed with antibiotics and surgery.

Subgaleal haematoma (SH) is a collection of blood between the bony skull and the loose connective tissue. It is almost a diagnosis confined to the neonatal age group with very few occurring beyond the age. Presentation could be sudden or chronic as deterioration in the cardio pulmonary status,shock, skin changes, airway obstruction and neurological sequealae.While assisted delivery with birth trauma are recognized causal factorsin the neonate, trauma to the head and blood related disorders have been reported to be major causes in older children and adults. Usually, the Small SH resolves spontaneously while the massive ones require active management; often with neuro surgical intervention. It also needs identifying the cause so as to treat and prevent a recurrence. We present a case of massive SH in a 5 year old mentally subnormal child with seizure disorder with a favourable outcome.

The mother brought her 3 1 2 -year-old son to a paediatric clinic as his forehead was swollen and bluish in appearance. She was unable to give any explanation for this lesion. Clinically it was noted that a very visible and also palpable, doughy swelling was present both in the forehead as well as the hard skull areas. Some hours later, a massive bilateral periocular haematoma appeared. Whilst X-rays were unable to provide any diagnostic help, the sonographic examination of the skull carried out on the same day revealed an extensive subgaleal haematoma. This phenomenon is described in radiological literature as "scalping" and is caused by the use of considerable, blunt violence against the head (shear stresses, e.g. by pulling at the hair). The mother's boyfriend later confessed forceful pulling of the hair.

A 15-year-old boy was presented to the emergency department with an enlarging head swelling after a minor head trauma 4 days previously. On examination, there was an extensive circumferential swelling of the entire scalp. Besides headache, the patient had no neurological deficits and was haemodynamically stable. For further evaluation, a non-enhanced CT of the head was conducted (see …

(2002). Massive subgaleal haematoma. British Journal of Neurosurgery: Vol. 16, No. 4, pp. 394-395.

We describe two patients who underwent intracranial aneurysm surgery and developed postoperative subgaleal haematomas which, in the presence of an unfixed bone flap, resulted in significant extradural compression and a marked clinical deterioration. The application of a pressure dressing to tamponade a developing scalp haematoma is unwise unless the bone flap has been rigidly fixed in place.