An unusual finding on the anterior fontanelle exam

  • Catarina Marques Pinho General and Family Practice, Unidade de Saúde Familiar Pevidém, Agrupamento de Centros de Saúde Alto Ave – Guimarães
  • Joana Vidal Teixeira General and Family Practice, Unidade de Saúde Familiar Pevidém, Agrupamento de Centros de Saúde Alto Ave – Guimarães
  • Antony Nogueira General and Family Practice, Unidade de Saúde Familiar Pevidém, Agrupamento de Centros de Saúde Alto Ave – Guimarães
  • Ana Ribeiro da Silva General and Family Practice, Unidade de Saúde Familiar Pevidém, Agrupamento de Centros de Saúde Alto Ave – Guimarães
  • Alexandra Martins General and Family Practice, Unidade de Saúde Familiar Pevidém, Agrupamento de Centros de Saúde Alto Ave – Guimarães
Keywords: Cranial fontanelles, Epidermal cyst, Magnetic resonance imaging, Ultrasonography

Abstract

Introduction: Palpation of the anterior fontanelle allows to investigate intracranial pressure and volume. Swelling of anterior fontanelle in a quiet baby examined in a supine position indicates high intracranial pressure, which may have distinctive causes, namely neoplasms.
Case report: A female infant, two months old, attended an emergency consultation at the Family Health Unit due to swelling in the anterior fontanelle. A soft nodular swelling with approximately one centimeter in diameter was observed at the fontanelle. Transfontanellar ultrasound revealed a potential epidermal cyst. The infant was referred to the Pediatric Surgery Department. Ultrasound was repeated two months later and revealed lesion growth. The infant was referred to the Neurosurgery Department, and a brain magnetic resonance imaging was performed. Absence of communication with endocranial structures was confirmed. Surveillance was maintained until fontanelle closure, aiming at later excision. Histological examination confirmed the diagnosis of dermoid cyst.
Discussion: Regular clinical follow-up supported by imaging studies revealed the benign nature of the lesion, allowing to postpone surgery.

References

– Fenichel GM. Clinical pediatric neurology: a signs and symptoms approach. 7th ed. Philadelphia: Saunders Elsevier; 2013.

– Drutz JE. The pediatric physical examination: HEENT. Dezembro, 2015. (Acedido em 17 de outubro 2016). Disponível em: http://www.uptodate.com/pt.

– David RB, Bodensteiner JB, Mandelbaum DE, Olson BJ. Clinical Pediatric Neurology. New York: DemosMedical; 2009.

– Stevenson DK, Benitz WE, Sunshine P, Hintz SR, Druzin ML. Fetal and Neonatal Brain Injury. 4th ed. Cambridge: Cambridge University Press; 2009.

– Lissauer T, Clayden G. Illustrated Textbook of Paediatrics. 3rd ed. London: Mosby Elsevier; 2007.

Published
2019-01-02
Section
Case Reports