Subperiosteal hematoma

Last revised by Henry Knipe on 24 Feb 2024

A subperiosteal hematoma occurs between the periosteum and the cortex of a bone and is therefore geographically limited to the affected bone.

Clinical presentation varies with location. Subperiosteal hematomas have been described in the calvarium, iliac bone, humerus, femur and tibia 1. In the limbs it often presents as a painful, firm, sometimes mobile mass. In the orbit it may present with proptosis +/- ocular deficits due to orbital compartment syndrome 2.

The most common cause is trauma resulting in rupture of the subperiosteal bridging veins, often with an accompanying fracture. Notable conditions include:

Non-traumatic causes include:

On plain radiographs and CT, it is often seen as a lenticular soft tissue density mass with overlying smooth periosteal reaction which may ossify on subsequent imaging or in chronic cases.

A lentiform subperiosteal lesion may be seen, which in the acute setting, has the following signal characteristics:

  • T1: hyperintense

  • T2: hyperintense

A fluid-fluid level may be seen.

Most resolve spontaneously. Peripheral calcification commonly occurs due to osteogenesis. Surgical intervention is often required if complicated by orbital compartment syndrome.

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