A forehead haematoma with an important diagnosis

Patients with undiagnosed bleeding disorders can present with varying clinical features ranging from innocuous bruising to life-threatening haemorrhage. Haemophilia is an X-linked recessive bleeding disorder causing a disruption within the intrinsic clotting pathway. After trauma, patients with Haemophilia experience an increased bleeding time with excessive bleeding into mucosal tissue, muscles and joints,¹ which carries a significant risk of morbidity and mortality.² The authors highlight the diagnostic and management actions undertaken for a paediatric patient, in whom Haemophilia A was an incidental finding, who suffered a craniofacial injury.

An 18-month-old child presented with his parents to the Emergency Department following a mechanical fall with a persistent and expanding forehead swelling. Clinically, a 5 x 4 cm firm swelling over the left frontal region was noted (Figure 1). There was no family history of bleeding disorders.

An urgent CT head was requested to rule out intracranial haemorrhage and fractures, which returned as normal (Figure 2). Haematological investigations revealed a factor VIII deficiency (< 0.01) indicating severe Haemophilia A. The haematoma was surgically drained under a general anaesthetic and the patient referred to a tertiary haematology centre for ongoing management.