Case 20

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A 14-month-old male is brought in for well-child care and is noted to have this finding on his left ear. Initially, his mother had not noticed it, but later she states that he fell off of the couch yesterday and may have sustained an injury to his ear at that time. She witnessed the fall and he landed on his side on the carpeted floor, but she did not think his ear or head struck the floor. The history does not reveal any other concerning symptoms. A careful physical examination reveals that there is also a smaller bruise on the other ear. There are no other concerning findings and he has no other bruises. He is a happy and otherwise healthy toddler.

Picture of child's ear. Full description below

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A photo of a left ear with bruising to the pinna in multiple areas, including on the outer helix and anti-helix mid-pinna.

What is the most appropriate next step?

A. Draw blood to check the platelet count.

B. Observe over the next few days to see if the bruising resolves.

C. Perform an emergency CT scan of his head.

D. Report to Child Protective Services and begin a work up for child abuse.