Pathological fracture and epidural hematoma as rare complications of calcified cephalohematoma.

Calcified cephalohematoma is generally regarded as a benign condition with cosmetic consequences. Because of its benign clinical course, reports with follow-up periods exceeding 10 years are lacking. To date, no reports have linked it to increased susceptibility to severe head trauma. Here, we describe a rare case of pathological fracture and acute epidural hematoma arising from trauma to a calcified cephalohematoma in an adolescent. A 15-year-old boy with a history of right parietal calcified cephalohematoma was followed up conservatively until the age of 3 years. During baseball practice, the patient fell backwards and struck the same region. After a lucid interval, the patient developed a headache, nausea, and left lower extremity weakness. Computed tomography scans revealed an acute epidural hematoma beneath the calcified cephalohematoma, which showed cystic changes and thinning of the outer table crossed by a fracture line. Emergency craniotomy with hematoma evacuation and cranioplasty was performed, which resulted in good neurological recovery. Histopathological examination confirmed irregularly thinned bone without malignancy. This case illustrates that calcified cephalohematomas with cystic cavities and fragile cranial tables may predispose patients to pathological fractures and life-threatening intracranial hemorrhage. Although rare, clinicians should inform patients and families of the potential risks, particularly individuals who participate in contact sports or activities at risk of head trauma.