Ecchymosis is caused by the leaking of blood from blood vessels into the subcutaneous tissue that underlies the skin. The most common cause is trauma (e.g., blunt force to the skin, leading to the rupture of capillaries) and it may affect various regions of the body. Ecchymosis of the eyes is also known as periorbital ecchymosis or raccoon eyes, which is indicative of a contusion or blunt injury that has caused a skull fracture. Periorbital ecchymosis can be associated with Battle sign, bruising in the mastoid region located behind the ear, and may suggest underlying brain trauma. Additionally, if someone is in a motor vehicle accident, they may develop an ecchymosis pattern in the distribution of a seatbelt across the abdomen, chest, and neck.
Underlying diseases can also predispose someone to
ecchymoses, including
aplastic anemia, which is a condition where the bone marrow halts production of new blood cells due to autoimmune destruction of stem cells in the bone marrow.
Leukemia,
acute renal failure,
cirrhosis,
clotting disorders (e.g.,
hemophilia,
Von Willebrand disease), and
vitamin K deficiency can also lead to
ecchymosis. If
ecchymoses are present surrounding the umbilical region, they are referred to as
Cullen sign and might suggest the presence of
liver cirrhosis,
pancreatitis, or a ruptured cyst within the abdominal cavity. Additionally, lateral abdominal wall bruising, known as Grey-Turner sign, raises suspicion for a ruptured
abdominal aneurysm,
ruptured spleen, an
intrauterine pregnancy, bilateral
salpingitis (i.e., inflammation of the
fallopian tubes), or hemorrhagic pancreatitis. Both Cullen sign and Grey-Turner sign indicate the presence of
retroperitoneal hemorrhage (i.e., bleeding stemming from the structures behind the
peritoneum, which is the membranous covering of the abdominal cavity).
