A subperiosteal hematoma occurs between the periosteum and the cortex of a bone and is therefore geographically limited to the affected bone.
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Clinical presentation
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.
Pathology
The most common cause is trauma resulting in rupture of the subperiosteal bridging veins, often with an accompanying fracture. Notable conditions include:
- cephalohematoma: subperiosteal hematoma of the skull following birth injury
- orbital subperiosteal hematoma: often difficult to differentiate from a retrobulbar hemorrhage
Non-traumatic causes include:
- metabolic disorders e.g. hypovitaminosis C (scurvy), rickets
- bleeding disorders e.g. hemophilia, liver disease
- sickle cell disease
Radiographic features
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. On MRI, it is T1 and T2 hyperintense in the acute setting and may demonstrate a fluid-fluid level.
Treatment and prognosis
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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