LAUSR

1. Mark Bouchard, MD* 2. Linda Di Toro, MD† 3. Jeremy Neuman, MD‡ 4. Richard Sidlow, MD* 5. Dana M. Kaplan, MD* 1. *Department of Pediatrics and 2. ‡Department of Radiology, Staten Island University Hospital—Northwell Health, Staten Island, NY 3. †Premier Pediatrics of New York, Staten Island, NY A 14-week-old boy, accompanied by his biological parents, presents to their pediatrician’s office after his mother noticed “bumps” on the child’s scalp that same morning. According to the pediatrician this is a new physical finding compared with his routine 2-month visit examination, and she directs the family to the emergency department for further evaluation. Both parents deny a history of head trauma; insect bites; changes in behavior, appetite, or activity; or recent fevers or illness. Birth history, confirmed by medical record review, is significant in that the patient was born full term via emergency cesarean delivery after a failed vacuum-assisted delivery. Bruising without swelling was noted on the scalp where the vacuum device was applied twice, which spontaneously resolved after several days. Scalp electrodes were also placed intravaginally during labor. In the emergency department, the patient’s development and growth, including head circumference, are both appropriate for age. There is no significant family medical history. Psychosocially, both parents deny a history of substance abuse, psychiatric comorbidities (including postpartum depression), previous investigations with child protective services, or domestic violence in the home. On physical examination the patient is active and alert, with scant, thin hair noted over the scalp without apparent breakages. The only abnormal finding is a 3×3-cm swelling noted over the occiput with extension over the right parietal …