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Elderly man with periumbilical and lower extremity ecchymosis
  1. Kai-Chun Hu,
  2. Ying-Kuo Liu,
  3. Yuan-Pin Hsu
  1. Emergency Department, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
  1. Correspondence to Dr Yuan-Pin Hsu, Emergency Department, Taipei Municipal Wan-Fang Hospital, Taipei 11696, Taiwan; koakoahsu{at}

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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.

Figure 1

Initial physical examination.


What is the most likely diagnosis for this patient?

  1. Retroperitoneal haemorrhage.

  2. Acute aortic …

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  • Contributors K-CH performed the search and wrote the manuscript. Y-KL and Y-PH checked and revised the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; internally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.