Subgaleal emphysema in a newborn: the “angel halo” sign

Excerpt

A term infant weighing 3,420 g was born by vacuum-assisted delivery after a 12-h labour. There was shoulder dystocia and the amniotic fluid was meconium-stained. Apgar scores were 5 at 1 min and 9 at 5 min. The infant required mask ventilation. At 7 h of age he developed acute swelling of the neck and upper thorax. Vital signs were normal. Chest radiograph revealed pneumomediastinum and subcutaneous emphysema of the neck and thorax. At 24 h there was increasing swelling of the scalp. Radiographs showed accumulation of air under the scalp resembling an angel’s halo (Figs. 1 and 2). Presumably mediastinal air had reached the scalp separating the galea aponeurotica from the outer table of the skull. At 7 days the subgaleal emphysema had reabsorbed. Subgaleal emphysema is a benign and exceedingly rare complication of pneumomediastinum occurring secondary to a difficult delivery [1, 2].

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