Elderly man with periumbilical and lower extremity ecchymosis

Clinical introduction A 91-year-old nursing home resident presented with sudden onset of ecchymosis over his bilateral lower limbs and periumbilical region 4 hours before arrival at the emergency department (figure 1). He had a history of atrial fibrillation, hypertension, right hemiparesis and motor aphasia due to an old cerebrovascular accident. Physical examination revealed bilateral non-palpable femoral, popliteal, dorsalis pedis and posterior tibial pulses, and cold bilateral lower extremities. He had a platelet count of 264 109/L and an international normalised ratio of 1.22. Question What is the most likely diagnosis for this patient? Retroperitoneal haemorrhage. Acute aortic occlusion. Disseminated intravascular coagulation. Acute pancreatitis. Answer: B Physical examination showed an ecchymosis around the umbilicus and ecchymosis pallor and mottled skin over the bilateral lower legs, reflecting the venous and capillary engorgement driven by an ischaemic vessel. A CT angiography...
Source: Emergency Medicine Journal - Category: Emergency Medicine Authors: Tags: EMJ Image Challenge Source Type: research