Cullen's sign in amoebic liver abscess

Non-traumatic ecchymoses: A literature review from a medico-legal perspective

Ecchymosis, as a general term, refers to discoloration of the skin due to the presence of extravasated blood into the dermis and/or subcutaneous tissue. However, it can occasionally be observed without any trauma, as a symptom of disease, a clinical condition, or even during the course of treating a disease. It is extremely important that these non-traumatic lesions are known and recognized and can be distinguished from traumatic ecchymoses by both clinicians and forensic scientists. This review of the literature includes detailed descriptions of non-traumatic periorbital ecchymosis, Slapped Cheek Syndrome, Cullen's Sign, Grey Turner's Sign, Stabler's Sign, Ransohoff Sign, Bryant's Sign, postsacral ecchymosis, perianal ecchymosis, Fox's Sign, other lower leg ecchymosis, and ecchymosis on various body regions. In this article, it is emphasized that failure to correctly identify these findings may subject practitioners to malpractice lawsuits, and failure to correctly identify findings by forensic experts may result in unjust legal judgments against people or loss of rights. It is also this review encourages accurate diagnosis of non-traumatic ecchymoses.

Cullen Sign and Grey Turner Sign Revisited

Cullen sign and Grey Turner sign, named after Thomas Stephen Cullen, MB, and George Grey Turner, MBBS, respectively, are signs of abdominal wall hemorrhage and are generally associated with acute pancreatitis. However, the research from which these signs arose was documented long before Cullen and Grey Turner made their contributions. The present article examines the history, pathologic mechanisms, and clinical application of these signs in relation to acute pancreatitis and ectopic pregnancy.

Eponymous signs in dermatology

Clinical signs reflect the sheer and close observatory quality of an astute physician. Many new dermatological signs both in clinical and diagnostic aspects of various dermatoses are being reported and no single book on dermatology literature gives a comprehensive list of these “signs” and postgraduate students in dermatology finds it difficult to have access to the description, as most of these resident doctor do not have access to the said journal articles. “Signs” commonly found in dermatologic literature with a brief discussion and explanation is reviewed in this paper.

Cullen's sign - Case report with a review of the literature

INTRODUCTION

Cullen's sign is described as superficial oedema with bruising in the subcutaneous fatty tissue around the peri-umbilical region. It is also known as peri-umbilical ecchymosis.

PRESENTATION OF CASE

We report a case of a fifty-three year old gentleman who presented with non-specific abdominal pain. Significant bruising was present within the subcutaneous fatty tissue on the anterior abdominal wall in keeping with 'Cullen's sign.' Of note he denied any alcohol intake and his amylase was normal. A diagnosis of pancreatitis was made following a CT scan of his abdomen.

DISCUSSION

A search of the entire English literature using PubMed with the phrase 'Cullen's sign' has been performed. Papers were reviewed in relation to recognition of this clinical sign, differential diagnosis, and management.

CONCLUSION

Our case and review of the literature highlights the rarity of this clinical sign which a clinician may encounter. In addition we draw to attention the importance of having knowledge of the underlying possible conditions which may lead to this sign, and can be vital in successful acute management.

Cullen’s sign following ultrasound-guided transvaginal oocyte retrieval

OBJECTIVE

To describe two cases of periumbilical hematoma (Cullen's sign) following ultrasound-guided transvaginal oocyte retrieval.

DESIGN

Case report.

SETTING

University-affiliated teaching hospital.

PATIENT(S)

Two patients, 34 and 32 years old, who developed Cullen's sign following ultrasound-guided transvaginal oocyte retrieval.

INTERVENTION(S)

Workup for pancreatitis and coagulopathies. Laparoscopy was preformed in one patient.

MAIN OUTCOME MEASURE(S)

Resolution of the symptoms.

RESULT(S)

Pancreatitis, coagulopathy, and massive hemoperitoneum were ruled out. Symptoms resided within two weeks.

CONCLUSION(S)

The appearance of a periumbilical hematoma (Cullen's sign) following ultrasound-guided transvaginal oocyte retrieval reflects a retroperitoneal hematoma of a benign course.

Amebic liver abscess

Amebic liver abscess is the most common extraintestinal manifestation of infection with Entamoeba histolytica, and it is associated with significant morbidity and mortality. In this article the most recent available information is reviewed relating to epidemiology, pathogenesis, presentation, diagnosis, and treatment. We reviewed thousands of cases of amebic liver abscess in the medical literature and present that information as it pertains to mortality, gender, anatomic location of abscesses, and clinical signs and symptoms.