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Ecchymosis: A Photo Essay
Published on Physicians Practice (http://www.physicianspractice.com)
Ecchymosis: A Photo Essay
Photoclinic [1] | January 28, 2013
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
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Ecchymosis: A Photo Essay
Published on Physicians Practice (http://www.physicianspractice.com)
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.
placement of triple-lumen femoral catheters during admission to the ICU.
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
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Ecchymosis: A Photo Essay
Published on Physicians Practice (http://www.physicianspractice.com)
Courtesy of Henry Schneiderman, MD.
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was implicated.
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.
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Ecchymosis: A Photo Essay
Published on Physicians Practice (http://www.physicianspractice.com)
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
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Ecchymosis: A Photo Essay
Published on Physicians Practice (http://www.physicianspractice.com)
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.
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Ecchymosis: A Photo Essay
Published on Physicians Practice (http://www.physicianspractice.com)
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.
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Ecchymosis: A Photo Essay
Published on Physicians Practice (http://www.physicianspractice.com)
Courtesy of William F. Keenan, MD.
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[1] http://www.physicianspractice.com/photoclinic
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