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Knot in head of newborn delivered by C-SECTION.

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My baby is 3 weeks old. Since she was born I noticed this knot on her forehead. She was a C-section baby so she had no trauma to the head during delivery. I was hoping it'd go away but it hasn't. At her 2 week check up I mentioned it to her pediatrician but she just said that was where her sutures were. Her answer didn't bring me any comfort. I've tried researching about the sutures but the images I see aren't the same nor is her head misshapened. Her head looks normal just the knot in the front. The knot doesn't have a ridge like I've seen in images. What could it be and should I be worried???

Category: Pediatrician

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Category: ICU/ Critical Care Specialist
 21 Doctors Online

Dear parent,
I can understand your concerns. Your observations are accurate. The frontal bone suture is called the metopic suture. Usually, prominence of the metopic suture looks like a linear swelling.
In your daughter's case, she has a rounded swelling that is located a bit superiorly.
Swellings in this location could be of one of the following etiologies:
1. Encephalocele or Encephalomyelocele
2. Sebaceous cyst
3. Dermoids
4. Subcutaneous fat necrosis
5. Rarer congenital causes
For differentiating these causes, you have to provide answers to the following questions:
Does the swelling feel bony or hard to touch?
Does the swelling move along the surface of bone?
Is the swelling soft or reducible ?
Does the swelling a very small punctum or an opening?
I would be able to help you better if you can answer the above queries.
Regards
Dr. Saptharishi L G


Patient replied :

Thank you for your response. To answer your questions, when touching the knot, it does not move. It just feels like skin over a round, raised, boney area. The boney area does not move either. The knot has no opening. It seems like her skull is raised in that are. I hope these answers help. Does something like this require surgery to fix?


Dear Parent,
Thank you very much. Your answers to the queries have definitely clarified a number of things.
Based on your description, it looks like a bony swelling. Definitely not an encephalocele (which is the most dangerous of the various diagnoses I had listed). It could be a hardened sebaceous cyst, but even that is unlikely. So at this point, we need to proceed further. We need the following:
1. X ray Skull lateral view
2. Ultrasound local part (swelling)
Based on these two investigations, we will plan further management. Remember, the purpose of these tests is to rule out something sinister. If it turns out to be just a hematoma or fat necrosis, we would be relieved and happy.


Dr. Saptharishi L G
Category: ICU/ Critical Care Specialist
Experience: 
Senior Residency: DM,  Pediatric Critical Care, PGIMER

Residency: MD, Pediatrics, Postgraduate Medical Education & Research (PGIMER), Chandigarh, 2013

Internship: JIPMER, 2009

Medical School: MBBS, Jawaharlal Institute of Post-graduate Medical Education & Research (JIPMER), Puducherry, 2008
Dr. Saptharishi L G and 4 other Medical Specialists are ready to help you

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