Cranium swelling in a young patient. Is this on your ddx list?

VRU, 2021

Ava Nowak, Ryan King, Agustina Anson

Background
Subperiosteal hematomas, accumulations of blood between bone and periosteum, are well-studied in human medicine but underreported in veterinary literature. This study aimed to describe the computed tomography (CT) appearance of calvarial subperiosteal hematomas in dogs following acute head trauma.

Methods

This retrospective, multi-institutional case series analyzed four dogs that underwent CT imaging for acute focal calvarial swelling following trauma. CT characteristics, including lesion appearance, anatomical location, and mineralization, were evaluated. Cytological or histopathological diagnoses were available for two cases.

Results

All dogs presented with ovoid, mass-like lesions with smoothly marginated mineralized outer shells and heterogeneously fluid to soft tissue-attenuating centers. The lesions were located primarily on the frontal or parietal bones, often crossing suture lines. Two cases were confirmed as subperiosteal hematomas via histopathology and cytology, showing connective tissue remodeling and hemorrhage. Follow-up indicated partial or complete resolution in two cases.

Limitations

The study included a small sample size and lacked histopathological confirmation in two cases. Additionally, CT may not reliably assess cranial suture closure, and long-term follow-up was limited.

Conclusions

Calvarial subperiosteal hematomas should be considered in the differential diagnosis for young dogs with focal calvarial swelling post-trauma. This study provides the first detailed CT characterization of these lesions in dogs, highlighting their soft tissue to fluid attenuation and peripheral mineralization. Further research with larger cohorts and long-term follow-up is recommended.

F I G U R E 4 Transverse CT images displayed in a bone window (window width = 2700, level = 350, slice thickness varied between studies)
illustrating the different appearances of the outer mineralized rim. In Dog 1 (A) centered at the temporomandibular joints (white arrows), the
lesion associated with the left parietal bone and is severely thickened compared to the others. In Dog 2 (B), Dog 3 (C), and Dog 4 (D) and the level of the frontal sinuses, the lesions are along the frontal bones (white arrowheads). The lesion is thicker in Dog 2 than Dogs 3 and 4. Right is to the left on all transverse CT images

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