Forehead “Goose Eggs”: A First Sign of Hemophilia?

Prominent forehead hematomas in young children could represent a coagulation disorder. Researchers retrospectively reviewed the medical records of 324 children with a diagnosis of hemophilia to identify those who presented with prominent forehead hematomas (see photo).

Overall, 84 children (26%) had a scalp hematoma at sometime during the chart review (1970–2009). In fourteen patients (17%; age range, 6 months to 11 years), a forehead “goose egg” was the only presenting manifestation of hemophilia. Twelve patients had factor VIII deficiency, and two had factor IX deficiency. Two patients (with factor VII deficiency) had severe hemophilia, seven patients had moderate hemophilia, and five had mild hemophilia. Forehead hematomas were often described as large, persistent, and causing parental distress. Three cases were aspirated or incised and drained by a primary care physician because of chronic or recurrent protuberance.