Grey Turner's sign suggesting retroperitoneal haemorrhage

Abstract

A 57-year-old man presented with dyspnoea and haemoptysis. He had a history of amyloid light-chain systemic amyloidosis with renal involvement and a remote history of pulmonary emboli. He was also currently taking lenalidomide. A ventilation-perfusion lung scan was in determinate for an acute pulmonary embolus (fi gure). Therefore, he was empirically anticoagulated with warfarin. Shortly after, he developed signifi cant epistaxis, gingival bleeding, and large bilateral fl ank ecchymoses (fi gure). His international normalised ratio was slightly high (4·5). The clinical presentation was most consistent with warfarin toxicity superimposed on the multifactorial haemostatic abnormalities of systemic amyloidosis. However, the Grey Turner sign suggested a large retroperitoneal haematoma. Warfarin was discontinued, an inferior vena cava fi lter was placed, and he was transfused several units of blood before eventually being discharged. Originally described by Grey Turner in 1920 as a sign of haemorrhagic pancreatitis, fl ank ecchymoses are caused by blood tracking subcutaneously from a retroperitoneal or intraperitoneal source. Lancet 2014; 383: 1920