engleski

Images in clinical medicine. Cullen's and Turner's signs.

A 72-year-old gentleman was admitted to the cardiovascular service with unstable angina from an outside facility after four days of heparin therapy. On the second day of hospitalization hemoglobin dropped from 11.7 to 9.4 g/dL. Physical exam revealed stable vital signs and a III/VI aortic stenosis murmur. Ecchymoses in the periumbilical (Cullen’ s sign) , groin (Fox’ s sign) and loin (Gray-Turner’ s sign) areas were noted. This was consistent with retroperitoneal hemorrhage. CT scanning confirmed this finding. We report this unusual case of all three physical signs in a single patient with retroperitoneal hemorrhage while on heparin therapy. Cullen was the first to describe an umbilical discoloration in a case of ruptured extrauterine pregnancy. In 1919, Turner described a “ dirty green” loin discoloration associated with acute pancreatitis. Fox’ s sign was first described in 1966 as upper thigh discoloration with a characteristic sharp upper margin. The largest study addressing Cullen’ s and Gray-Turner’ s sign presented 770 patients with acute pancreatitis. 3% incidence and 37% mortality was associated with appearance of one or both signs. We stress that though most commonly described in hemorrhagic pancreatitis, none of these signs are specific for this condition.

Cullen's sign; Turner's sign; retroperitoneal hemorrhage

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