Presentation
Uneventful normal delivery. Incidental finding of a depressed skull on clinical examination. Normal Moro reflex.
Patient Data
Concave depression of the left parietal bone seen on AP view. No overlying soft tissue or scalp swelling. Other skull bones are unremarkable.
Impression:
Depressed left parietal bone without soft tissue swelling suggestive of faulty fetal packing. The appearances are very similar with depressed skull fractures, thus needs clinical correlation.
Case Discussion
Faulty fetal packing is a rare reversible calvarial deformity. It occurs in 1 in 10,000 births.
Recognized causes of faulty fetal packing include extrinsic pressure from bony prominence, uterine fibroid, fetal own hand and foot or body part of a twin.
The radiographic appearance of faulty fetal packing is very similar with depressed skull fractures.
Therefore, clinical correlations needed as the two conditions have different etiology.
In fetal faulty packing, follow up is recommended as spontaneous resolution often occurs after few months of life, without leaving any cosmetic or neurological sequelae.
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