Auricular Hematoma
A 17-year-old boy presented to the emergency department with progressive swelling and bruising of the right ear. He had a history of autism and self-injurious episodes characterized by hitting his head on the floor. The most recent such occurrence was 1 day before presentation. On examination, he was alert and not in any apparent distress. A minor laceration was noted above the left eyebrow. Examination of the right ear revealed marked swelling with fluctuance, overlying ecchymosis, and a loss of cartilaginous landmarks, findings consistent with an auricular hematoma (Panel A). In the operating room, urgent drainage of the hematoma was performed (Panel B) and several bolsters were shaped to the contours of the ear and sutured in place. On the third day after the procedure, the bolsters were removed. During the month after the initial presentation, he had two additional self-injurious episodes, with recurrence of the right auricular hematoma. Operative drainage and bolster-application procedures were performed both times. At follow-up in the outpatient clinic 6 months after the last procedure, examination of the ear showed some thickening of the auricular cartilage and contour loss.
