{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T09:48:45Z","timestamp":1785836925505,"version":"3.56.0"},"reference-count":9,"publisher":"MDPI AG","issue":"15","license":[{"start":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T00:00:00Z","timestamp":1785801600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Subgaleal hemorrhage is uncommon in infants beyond the newborn period and, when disproportionate to the reported causal trauma, raises suspicion for child abuse. We describe a 9-month-old girl who developed a large right subgaleal and small epidural hematoma after a 50 cm fall. Initial abuse evaluation was negative, and standard coagulation tests were normal, although von Willebrand factor (vWF) activity was elevated. However, repeat testing 2 months later revealed markedly reduced vWF antigen and activity, suggestive of type 1 von Willebrand disease (vWD). This case highlights that disproportionate bleeding after minor head trauma should prompt evaluation for both non-accidental injury and occult bleeding disorders, and that variability in vWF levels necessitates repeat testing for accurate interpretation.<\/jats:p>","DOI":"10.3390\/diagnostics16152459","type":"journal-article","created":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T09:15:22Z","timestamp":1785834922000},"page":"2459","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Disproportionate Subgaleal Hemorrhage in an Infant: Abuse or Bleeding Disorder?"],"prefix":"10.3390","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0901-0654","authenticated-orcid":false,"given":"Chih-Hao","family":"Wang","sequence":"first","affiliation":[{"name":"Department of Pediatrics, MacKay Children\u2019s Hospital, Taipei 104217, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1812-2041","authenticated-orcid":false,"given":"Po-Chih","family":"Lin","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, MacKay Children\u2019s Hospital, Taipei 104217, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jen-Yin","family":"Hou","sequence":"additional","affiliation":[{"name":"School of Medicine, College of Medicine, MacKay Medical University, New Taipei City 252005, Taiwan"},{"name":"Division of Pediatric Hematology-Oncology, MacKay Memorial Hospital, Taipei 104217, Taiwan"},{"name":"Division of Pediatric Hematology-Oncology, MacKay Children\u2019s Hospital, Taipei 104217, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,8,4]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1160","DOI":"10.1016\/S0140-6736(09)61558-0","article-title":"Identification of children at very low risk of clinically-important brain injuries after head trauma: A prospective cohort study","volume":"374","author":"Kuppermann","year":"2009","journal-title":"Lancet"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"167","DOI":"10.1038\/s41372-024-02116-w","article-title":"Subgaleal hemorrhage in neonates: A comprehensive review and summary recommendations","volume":"45","author":"Babata","year":"2025","journal-title":"J. Perinatol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"5870","DOI":"10.1182\/bloodadvances.2025016485","article-title":"Diagnosis of von Willebrand disease","volume":"9","author":"Bowman","year":"2025","journal-title":"Blood Adv."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"81","DOI":"10.1016\/j.pedneo.2022.07.003","article-title":"Sonographic diagnosis of intramural duodenal hematoma","volume":"64","author":"Wang","year":"2023","journal-title":"Pediatr. Neonatol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"85","DOI":"10.11613\/BM.2022.010707","article-title":"Reevaluation of von Willebrand disease diagnosis in a Croatian paediatric cohort combining bleeding scores, phenotypic laboratory assays and next generation sequencing: A pilot study","volume":"32","author":"Zadro","year":"2022","journal-title":"Biochem. Med."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"2375","DOI":"10.1111\/jth.14304","article-title":"Genetic regulation of plasma von Willebrand factor levels in health and disease","volume":"16","author":"Swystun","year":"2018","journal-title":"J. Thromb. Haemost."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"14","DOI":"10.1080\/09537104.2021.1962837","article-title":"Neonatal platelet physiology and implications for transfusion","volume":"33","year":"2022","journal-title":"Platelets"},{"key":"ref_8","first-page":"e57194","article-title":"Exploring the Depths: A Case Report of a Record-Breaking Subgaleal Hematoma Uncovered","volume":"16","author":"Venu","year":"2024","journal-title":"Cureus"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"e948814","DOI":"10.12659\/AJCR.948814","article-title":"Subgaleal Hematoma in a Pediatric Patient with Factor XI Deficiency: A Case Report of Combined Rare Pathologies","volume":"26","author":"Almutawah","year":"2025","journal-title":"Am. J. Case Rep."}],"container-title":["Diagnostics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4418\/16\/15\/2459\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T09:42:29Z","timestamp":1785836549000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4418\/16\/15\/2459"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,4]]},"references-count":9,"journal-issue":{"issue":"15","published-online":{"date-parts":[[2026,8]]}},"alternative-id":["diagnostics16152459"],"URL":"https:\/\/doi.org\/10.3390\/diagnostics16152459","relation":{},"ISSN":["2075-4418"],"issn-type":[{"value":"2075-4418","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,4]]}}}