A Teenage Boy with Right Forehead Swelling Following Trauma to the Head

Aviva P. Aiden; McKenna E. Boyd; John M. Carey; Shabana Yusuf

doi:10.1542/pir.2019-0018

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Aviva P. Aiden, MD, PhD*,^†,^‡
McKenna E. Boyd, MS^§
John M. Carey, MD*
Shabana Yusuf, MD, MEd*

^*Division of Pediatrics Emergency Medicine, Department of Pediatrics,
^†Department of Molecular & Human Genetics, Baylor College of Medicine and Texas Children’s Hospital, Houston, TX;
^‡Department of Bioengineering, Rice University, Houston, TX;
^§Office of Student Affairs, Baylor College of Medicine, Houston, TX

Address correspondence to Shabana Yusuf, MD, MEd, Associate Professor of Pediatrics, Division of Pediatrics Emergency Medicine, Department of Pediatrics, Baylor College of Medicine and Texas Children’s Hospital, 6621 Fannin St A2210, Houston, TX 77030-2399. E-mail: syusuf{at}bcm.edu

AUTHOR DISCLOSURE
Drs Aiden, Carey, and Yusuf and Ms Boyd have disclosed no financial relationships relevant to this article. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.

Case Presentation

A 15-year-old boy presented to the emergency department (ED) with headache and swelling to his right forehead after a fall. The fall was unwitnessed, but the patient reports he hit his head and briefly lost consciousness. It was unclear if the patient had a syncopal event leading to the fall, or had a loss of consciousness due to the head injury resulting from the fall. On review of systems, he reported a headache that had started after the fall earlier that day, and nasal congestion with rhinorrhea for the past several days. Almost 2 weeks before, he had a headache which lasted for 1 day. The remainder of the review of systems was negative.

The patient reported a vague history of a cardiac problem, and the patient’s mother reported that he was supposed to avoid sports, but had not been evaluated by a cardiologist and had not been prescribed any medications. No records were available regarding this medical history, and the patient and parent were unable to elaborate further. There was no family history of congenital heart disease, sudden death, or arrhythmias.

On arrival to the ED, he was febrile to 102°F (38.9°C) and tachycardic at 118 beats/min. On physical examination, he was noted to have tender right frontal scalp swelling without fluctuance. He had nasal congestion but no other facial tenderness and normal dentition. His mental status, neurological examination, and the remainder of his physical examination including his cardiac and lung examination were all normal. Evaluation with noncontrast computed tomography (CT) scan of the head revealed “paranasal sinus disease with fluid levels in the frontal …