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
Radiographic features
Plain radiograph and CT
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 or in chronic cases.
MRI
A lentiform subperiosteal lesion may be seen, which in the acute setting, has the following signal characteristics:
T1: hyperintense
T2: hyperintense
A fluid-fluid level may be seen.
Treatment and prognosis
Most resolve spontaneously. Peripheral calcification commonly occurs due to osteogenesis. Surgical intervention is often required if complicated by orbital compartment syndrome.