Vascular Malformation vs. Growing Skull Fracture
Left picture: The diagnosis is a vascular malformation, combined with a hemangioma. Right picture: Here, a so-called growing skull fracture is present which is due to a simultaneous laceration of the dura, and which is a characteristic type of skull fracture in the newborn and in early infancy. Due to the non-damped pulsation of the brain, the fracture is not healing and becomes larger and larger, with a leptomeningeal cyst developing underneath the galea. The skull x-ray at the bottom shows an increasingly larger parietal skull fracture.
Both neonates have a mass which lies distinctly lateral to the midline. Left picture: This mass of soft tissue is situated above the right auricle in the parietooccipital region, is very prominent, exhibits a reddish discoloration in its anterior part, increases on crying, and has been present since birth. Right picture: This high-parietal mass in the picture at the top is much less striking, seems to continuously blend with its surroundings, has grown gradually, and is pulsating on looking closely. Left picture: Neither a perinatal nor a postnatal trauma is known. Right picture: In this child a fall has been observed. Compare with the figure at the bottom which shows one of repeated skull x-rays in a similar case.