Abstract
A 72-year-old man with unstable angina was admitted to the hospital. On the sixth day of heparin therapy, the hemoglobin level decreased from 11.7 to 9.4 g per deciliter. On physical examination, the vital signs were stable, and there was a grade 3/6 systolic murmur consistent with aortic stenosis. Ecchymoses in the periumbilical region (Cullen's sign) (Panel A) and flank (Turner's sign) (Panel B) were noted. Computed tomographic scanning confirmed a retroperitoneal hemorrhage. In 1918, Cullen was the first to describe an umbilical discoloration in a patient with a ruptured extrauterine pregnancy. In 1919, Turner described a “dirty green” discoloration . . .
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