Krwiak podokostnowy, czyli wynaczynienie krwi z pękniętych naczyń pomiędzy oponą twardą a okostną, występuje najczęściej u noworodków w wyniku urazów okołoporodowych. Jak przejawia się ten uraz i w jaki sposób przebiega jego leczenie?
Jak dochodzi do krwiaka podokostnowego?
Krwiak podokostnowy występuje u 2-3 proc. noworodków. Rozwój tego schorzenia u dziecka najczęściej jest związany z zakończeniem ciąży porodem zabiegowym (tzn. z zastosowaniem podczas porodu kleszczy lub próżnociągu). Krwiak podokostnowy może się rozwinąć również w następstwie urazu okołoporodowego, w wyniku działania na dziecko zbyt dużych sił (np. z powodu nasilonych skurczów macicy) lub w przypadku kiedy poród przebiega zbyt szybko lub występują trudności z przejściem dziecka przez kanał rodny.
Krwiak podokostnowy w zdecydowanej większości przypadków ogranicza się do jednej kości, najczęściej ciemieniowej. Może się rozwijać obustronnie.
Objawy krwiaka podokostnowego
Diagnozę krwiaka podokostnowego ustala się na podstawie badania palpacyjnego lub badania obrazowego (tomografia komputerowa lub rezonans magnetyczny). W praktyce klinicznej obecna jest także diafanoskopia czaszki, czyli nieinwazyjna metoda diagnostyki polegająca na prześwietleniu sklepienia czaszki za pomocą silnego światła.
Krwiak podokostnowy przejawia się ogniskowym obrzękiem w obrębie czaszki. Krwiak początkowo jest miękki, wraz z upływem czasu ulega wapnieniu i twardnieniu na krawędziach, przez co może doprowadzić do deformacji czaszki. Deformacja ta ustępuje jednak samoistnie w przeciągu kilku miesięcy, do trwałej zmiany kształtu czaszki dochodzi w rzadkich przypadkach.
Objętość krwi, która ulega wynaczynieniu, jest zazwyczaj niewielka, w związku z czym w większości przypadków nie występuje następowa niedokrwistość.
W ok. 5 proc. przypadków wystąpienie krwiaka podokostnowego ma związek ze złamaniem kości czaszki. W takim wypadku mogą wystąpić objawy neurologiczne i dodatkowe powikłania.
Leczenie krwiaka podokostnowego
W większości przypadków krwiak podokostnowy nie wymaga wdrażania leczenia. Krwiak ulega samoistnemu wchłonięciu zwykle w przeciągu dwóch tygodni od porodu.
Powikłania krwiaka podokostnowego
Wśród najpoważniejszych powikłań, jakie mogą wystąpić u noworodka z powodu krwiaka podokostnowego, wymienia się żółtaczkę noworodkową oraz anemię.
Żółtaczka noworodkowa spowodowana jest nasilonym rozpadem erytrocytów w obrębie krwiaka i podwyższeniem poziomu bilirubiny we krwi. Anemia może natomiast wystąpić w przypadku krwiaka podokostnowego o dużych rozmiarach. Obserwuje się wtedy bladość skóry i obniżenie ciśnienia krwi. W niektórych przypadkach może dojść do tachykardii lub utraty przytomności.
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