A HEALTHY 2-week-old boy was seen for his initial well-child examination and was noted to have a 3 × 2-cm firm raised lesion over his occipital area. There was no history of trauma since his birth. The birth history consisted of an infant born at 39 weeks' gestation to a 27-year-old primigravida mother who was preeclamptic and had positive culture findings for group B streptococcus. The delivery was notable for shoulder distocia and nuchal cord. After delivery the infant had a bruised head and petechiae over his entire face. There was no swelling in the occipital area. The patient did well and was discharged home on day 2 of life without complications.
Findings from physical examination were unremarkable except for a 2 × 3-cm swelling over the occipital area and crepitus palpable along the transverse occipital suture line. He had normal findings on neurological examination. There was concern regarding possible fracture from abuse or trauma sustained at birth. Skull radiographs were obtained (Figure 1 and Figure 2).
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