A patient presents with significant coughing, described as “violent” and develops left flank pain a few days later. He takes analgesics for the pain and presents with bruising on his left flank which tracks to his umbilicus.  Review of his bloodwork shows a normal CBC with INR of 1.0 and PTT of 25s and normal liver function tests. CT scans of the abdomen show a normal pancreas and no intra-abdominal collections but signs of subcutaneous stranding that might be suggestive of a hematoma.

ANSWER:

This is actually a case of spontaneous bleeding in a patient taking ASA, and dual over the counter NSAID therapy for pain. The appearance is very suggestive of a retroperitoneal bleed (Grey Turner sign) but the CT scans of the abdomen showed no signs of such. Additionally, his coagulation profile was normal. Upon cessation of the NSAIDs the bruising which had persisted for weeks resolved.