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BMJ Case Reports 2009; doi:10.1136/bcr.06.2008.0030
  • Case report

Spontaneous haematoma of the pinna

  1. Ravinder Singh Natt,
  2. Ray Clarke
  1. Royal Liverpool Childrens’ Hospital, Ear, Nose And Throat, Alder Hey, Eaton Road, Liverpool, L12 2AP, UK
  1. Ravinder Singh Natt, ravindernatt{at}hotmail.com
  • Published 17 March 2009

A 5-week-old boy was seen with a 4 hour history of a spontaneous haematoma of the left ear pinna without a preceding history of trauma (fig 1). Aspiration of 0.5 mL of serosanguinous fluid coupled with a compression dressing was effective in managing the haematoma, and no cosmetic deformity resulted. Prompt treatment of such haematomas is advised to prevent deformity of the pinna. All haematological and clotting serological investigations did not find any abnormality.

Figure 1

Photograph of left spontaneous pinna haematoma.

The patient was born by an uncomplicated vaginal delivery at term gestation and no haematoma was identified until 5 weeks later, excluding a traumatic aetiology from birth.

Although spontaneous haematoma of the ear is extremely rare and a review of the literature has not identified any published case reports, it is imperative to consider non-accidental injury as a potential causative factor. In this particular case all relevant guidelines and protocols were followed and subsequent investigations were completed but were unable to demonstrate co-existence of non-accidental injury.

BACKGROUND

A review of the world literature has not identified any published articles of a spontaneous pinna haematoma, particularly in a neonate. In addition, this case emphasises that the awareness of child protection is everyone’s responsibility and involves every sector of society.

CASE PRESENTATION

A 5-week-old boy was referred with a 4 hour history of a spontaneous haematoma of the left ear pinna without a preceding history of trauma. There was no history of previous ecchymosis affecting other regions of his body. The patient was born by an uncomplicated vaginal delivery at term gestation and no haematoma was identified until 5 weeks later, excluding a traumatic aetiology from birth. The child’s mother was employed as a social care worker.

INVESTIGATIONS

No abnormality was found using haematological and clotting serological investigations. Blood glucose testing (BM Test Glycemie; BCL Boehringer Corporation Ltd, Bell Lane, Lewes, East Sussex, UK) did not demonstrate hyperglycaemia.

DIFFERENTIAL DIAGNOSIS

In general differential diagnosis of lesions of the pinna other than a haematoma include: perichondritis, sebaceous cyst, seroma, keloid malformation, malignancy, haemangioma and dermoid cyst.

TREATMENT

Aspiration of 0.5 ml of serosanguinous fluid coupled using an aseptic technique with a compression dressing was effective in managing the haematoma.

OUTCOME AND FOLLOW-UP

No cosmetic deformity resulted after discharge. A further telephone assessment with the mother confirmed no reformation of the haematoma 3 months later and there was no permanent disfigurement.

DISCUSSION

A haematoma of the pinna is characteristically the result of direct blunt trauma, most commonly on the anterior aspect with associated findings of tenderness, discolouration and swelling. Cartilage necrosis is a likely consequence of delayed intervention, due to the disruption of the adherence between the perichondrium layer and the ear cartilage ,which is replaced by the developing haematoma. Hence prompt intervention is essential to avoid permanent cosmetic deformity including fibrosis (cauliflower ear), commonly seen in rugby players and wrestlers.2

Investigations should aim to exclude haematological and clotting abnormalities. Diabetes mellitus can be an aggravating factor and needs to be identified and subsequently controlled to prevent complications including infection and subsequent cosmetic deformity.

A systematic review published in the Cochrane database reported that no particular method of managing a pinna haematoma is markedly more effective in achieving a favourable cosmetic outcome. However, the review does support the role of intervention, either by needle aspiration or by incision and drainage of the haematoma, rather than no treatment.3

Although spontaneous haematoma of the ear is extremely rare and a review of the literature has not identified any published case reports, it is imperative to consider non-accidental injury as a potential causative factor.1 Importantly, child abuse exists across all religious, socioeconomic and ethnic sectors of society. Hesitation in recognising abuse or inaugurating appropriate action may result in escalation of injury severity. In this particular case, all relevant guidelines and protocols were followed and subsequent investigations were completed but there was no evidence of coexistence of non-accidental injury.

LEARNING POINTS

  • Lesions of the pinna can lead to gross disfigurement and change the cosmetic appeal of the face as a whole.

  • Delays in diagnosis and subsequent mismanagement can lead to overt disfigurement.

  • Recognition and subsequent assessment of non-accidental injury is fundamentally the responsibility of all healthcare workers to prevent further abuse in this vulnerable population.

Footnotes

  • Competing interests: none.

  • Patient consent: Patient/guardian consent was obtained for publication.

REFERENCES

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