Head Swelling After Hair Braiding In A 6-Year-Old Girl

Oluwaseun Odewole, MD, MPH*,‡2. Chelsea Marion, MD†,‡3. Sheila Goel, MD‡,§ 1. *Department of Family Medicine and2. †Department of Pediatrics, Morehouse School of Medicine, Atlanta, GA3. ‡Children’s Healthcare of Atlanta, Atlanta, GA4. §Division of Emergency Medicine, Department of Pediatrics, Emory University School of Medicine, Atlanta, GAA 6-year-old previously healthy African American girl presents with scalp and forehead swelling of a few hoursu0027 duration. The patient woke up with tender scalp swelling associated with mild headache. She denies any preceding history of fall or trauma to the head. There is no personal or family history of bleeding disorder and no hematuria, epistaxis, easy bruising, or muscle/joint pain or swelling. On further questioning, she endorses that her hair was braided the night before by her sister and that the braids felt somewhat tight.Vital signs at presentation are within normal limits. Examination reveals a boggy, swollen, and tender forehead swelling extending posteriorly to the parietal and temporal scalp bilaterally. The remainder of the examination findings are normal.Her hemoglobin level is 12.0 g/dL (120 g/L), white blood cell count is 7,600/μL (7.6×109/L), and platelet count is 229,000/μL (229×109/L). Her coagulation panel is normal. A skull radiograph shows a right parietal scalp soft tissue swelling with no underlying skull fractures or radio-opaque foreign body. The grandmother is asked to undo the child’s …