1. Extensive ecchymoses following a fall
A 72-year-old man slipped and fell backward in the bathroom, hitting his
head on the toilet seat; he suffered only minimal discomfort. The following
day, he presented with mild back pain and extensive bruising.
Impressive ecchymoses extended from his left flank to his right flank,
across the midline, where a tender mass was palpated. Swelling was visible
from a distance at the L4 level; the 17 X 10-cm lesion was raised approximately
1.5 cm, with overlying black-blue ecchymoses. The patient was taking
self-prescribed baby aspirin, 81 mg/d; vitamins C, E, and B12; and Ginkgo
biloba, 400 mg/d.
Could the fall alone have caused this extensive bruise—or is something