Author: Amanda King / Editor: Steve Corry-Bass / Reviewer: Amanda King / Codes: IC6, SaP2, SLO5, TP1Published: 22/11/2023

A 5-year-old boy presents to Emergency Medicine (ED) with a central boggy swelling to his forehead that has arisen over the last 24 hours. It looks purple and bruised. No history of trauma reported from Mum. He has had some on and off coryzal symptoms over the last two weeks and vomited three times yesterday. He was taken to see his GP who diagnosed him with possible gastroenteritis. Mum reports that he was febrile yesterday but afebrile now, she is worried about this new swelling on his head.

There are no safeguarding alerts.

Normal observations have been documented at triage.O/E: You notice that he is tender over the boggy circular swelling which is 5cm in diameter and the inferior edge has a purplish bruise appearance, with no other evidence of bruises/injuries. He has persistent rhinorrhoea but ENT examination is normal. He is clingy to mum and frequently crying but otherwise behaviourally appropriate and neurologically intact.

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