Zebra Cards > Samples > AB-006 


    Card AB-006
Bilateral loin or flank discolorations of a dirty greenish color
Back of Card AB-006
  • Grey Turner sign1, 2

Differential Diagnosis

  • hemorrhagic pancreatitis
  • ruptured aortic aneurysm
  • ruptured ectopic pregnancy


Both the Grey Turner sign and the Cullen sign (card AB-002) are thought to result from the tracking of blood-stained retroperitoneal fluid through the tissues of the abdominal wall or along the falciform ligament to the umbilical area. We will refer to them collectively as body wall ecchymoses (BWE).

In a series of 23 patients with BWE (representing 3% of 770 consecutive patients hospitalized for pancreatitis), the mean age was 56 (range, 20 to 83); 75% were women, and all major causes of pancreatitis were represented. BWE appeared most commonly on the fourth hospital day (range, 2 to 6); 40% had the Cullen sign, 40% the Grey Turner, and 20% had both.3

By objective criteria, 87% of those with BWE had "severe" pancreatitis, and 96% suffered "serious" complications; 37% died, but the presence of BWE was not an independent risk factor for death. Age, however, was important: Those with BWE who were under age 54 all survived, while those over 70 all died soon after the sign appeared. Of those surviving longer than 5 days, 37% developed pseudocysts.3


(1) Br J Surg. 7:394-395 (1919). Turner's original description. (Grey was his middle name.)

(2) JAMA. 247:2754 only (1982). Large color photo.

(3) Surg Gynecol Obstet. 159:343-347 (1984). Study from Scotland. Also see card TH-007.

   Zebra Cards: An Aid to Obscure Diagnoses. JG Sotos. Philadephia: American College of Physicians, 1989. ISBN 0-943126-13-4. Copyright © 1989 American College of Physicians. All Rights Reserved. Phone: 1-800-523-1546.
Click here to see the updates for this card, including links to Medline. Back to page of sample cards.
©1986-2000 John Sotos, MD. All rights reserved.

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