VizD Vol 2.1

Case 2.1

A 23-year-old man presents to your ED after being in a bar fight.  The patient states he received multiple punches to his head and face.  You note the following finding on exam.


1. What is the diagnosis?

2. What is the treatment in the ED?

3. What is a complication of this condition?

Please post your answer in the “reply box” or click on the “comments” link  You will not see your answer post until next week when all of the submitted answers will be posted.  Good luck!

VizD is a weekly contest of an interesting or pathognomonic image from emergency medicine. Its goal is to integrate learning into a fun and relaxed environment. All images are original and are posted with the consent of the patient.

12 Responses

  1. 1. Auricular hematoma

    2. Drainage of the hematoma, compression dressing, antibiotics

    3. Complications are infection, asymmetric cartilage formation (cauliflower ear), hematoma reaccumulation

  2. This is an Auricular hematoma. It should be drained and have a conforming dressing applied to prevent it from recurring. Conforming dressings for an ear are elegant to create and apply but take some skill and special equipment to create. Without treatment it can go on to be a Cauliflower ear, which is ugly. Wikipedia says they are “common among amateur wrestlers, rugby players, mixed martial artists, mupps and grapplers”. I would like to know what a MUPP is. Ugly means loss of conjugal bliss, which is still worth more than four years of med school tuition.

  3. 1) Auricular hematoma
    2) Sterile I&D, supportive pressure dressing to prevent hematoma
    3) Califlower ear

  4. 1. hematoma auris
    2. I and D. resuture. nonpressure bandage. abx ointment and f/u 24hrs looking for recollection.
    3. distorted cartilage regrowth leading to “cauliflower ear” and poor cosmesis.

  5. 1. Dx – periauricular hematoma
    2. TX – incision and drainage in the ED with packing and special care as to dressing applied post treatment to avoid reaccumulation of blood.
    3. Complication – “cauliflour ear” deformity of collapsed cartilage

  6. Cauliflower ear!
    Drain and compression tie.
    Complications: Infection, ear drum rupture.

  7. 1. Otohematoma

    2. Either, if possible, immediate referral to ENT specialist for surgical drainage (i.e. incision) or if ENT service is not available and not familiar with surgical technique aspiration and padding in contour with the ear and subsequent referral. NB. If only aspiration is achieved this may need to be redone. In both cases compression bandage is needed.

    3. Cauliflower ear.

  8. 1) Subperichondrial hematoma
    2) If less than 7 days old, needle aspiration and/or I&D, compression dressing, antibiotics
    3) Reaccumulation of hematoma, infection, chondritis, scar formation (resulting in cauliflower ear)

  9. 1. A perichondrial hematoma

    2. You want to I and D the hematoma, then place a firm compression dressing on it to prevent the hematoma from re-accumulating.

    3. Local infection; deformation of the ear cartilage (a cauliflower ear)

  10. 1. Auricular hematoma
    2. I&D of hematoma, pressure dressing such as sutured-secured bolsters, and antibiotics
    3. “Cauliflower ear”

  11. 1. Perichondrial Hematoma (postraumatic chondritis)
    2. ED treatment: Remove fluid collection by making an incision through the skin and maintain pressure in area with a compressive dressing which maintains normal ear contours. Reassess in 24H.
    3. If the hematoma is not drained, can result in an asymmetrical formation and new cartilage and deformity of the auricle (cauliflower ear).

  12. 1. Auricular Hematoma
    2. Evacuation by needle drainage or I&D, compression dressing to prevent re-accumulation, antibiotics, daily re-evaluation (if < 7days), ENT consult or referral.
    3. Cauliflower Ear

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