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Ecchymosis: A Photo Essay


Ecchymosis is caused by the rupture of small blood vessels beneath the skin. Some causes are benign, others may herald dangerous disease.

This large macular area of ecchymosis on the thigh of a 26-year-old woman was found to be a sign of underlying acute lymphocytic leukemia. She had denied any trauma to this and other affected sites and was ingesting no suspect medications or dietary supplements. In the absence of clear cause, “spontaneous” bruising should be considered an urgent medical problem.

Courtesy of Ted Rosen, MD.

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The severe bilateral hematomas seen on the thigh of this elderly patient are the result of failed placement of triple-lumen femoral catheters during admission to the ICU.

Courtesy of Henry Schneiderman, MD and Sweet F. Ver, MD.

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The severe orbital bruising seen here and the lateral subconjunctival hemorrhage are the result of intimate partner violence against a 35-year old woman. She also had ecchymoses on all 4 extremities, her posterior shoulders, posterior neck, and left lumbar and sacral areas.

Courtesy of Robert P. Blereau, MD.

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The extensive purple ecchymoses and red raised lesions seen here were found on the legs of an elderly woman. Smaller but similar areas were seen on the arms. A diagnosis of a severe drug reaction was made based on the patient’s history and lack of other possible causes. Cephalosporin was implicated.

Courtesy of Henry Schneiderman, MD.

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The distinct circular ecchymoses seen here were noted on the back of a 57-year-old Vietnamese woman who presented to the ED with worsening respiratory symptoms and fever. The lesions were found to be the result of cupping, a therapeutic maneuver used in alternative medicine and, in this case, by the patient's husband in attempt to relieve his wife's upper respiratory tract symptoms.

Courtesy of Fawad Shaheen, MD.

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A Cullen sign, seen here, is a periumbilical ecchymosis classically associated with hemorrhagic pancreatitis. In this patient, the ecchymosis resulted from a rectus sheath hematoma caused by violent coughing.

Courtesy of D. Brady Pregerson, MD.

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This large, firm, ecchymotic and exquisitely tender mass was seen over the left side of the abdomen of a 77-year-old woman. The medical history revealed she was taking warfarin and she had fallen in her home a few days earlier. A CT scan without contrast of the abdomen and pelvis showed a massive abdominal wall hematoma arising from the left rectus sheath of the lateral abdominal wall with a fluid-blood level consistent with an acute hemorrhage.

Courtesy of Donald Wickline, MD, Michael D. Smith, MD, and David Effron, MD.

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This patient, who had a history of arthritis, reported that she had previously had a small lump behind her knee. The small area of ecchymosis on her heel suggests that blood has tracked down her leg. Given the factors in the history that cast doubt on the diagnosis of DVT, a tentative diagnosis of ruptured synovial cyst was made.

Courtesy of William F. Keenan, MD.

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