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Review
of Clinical Signs

Cullen’s Sign

Series Editor and Author: Frank L. Urbano, MD

1. Which of the following statements about Cullen’s sign is true?
  1. It may result from a hemothorax.
  2. In all cases, it occurs when pancreatic enzymes react with abdominal adipose tissue.
  3. It is characterized by a bluish or purple discoloration around the navel.
  4. It is associated with pancreatic cancer.
  5. It is a normal sign of pregnancy.
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2. All of the following statements about Cullen’s sign are true EXCEPT:

  1. It has been described in patients with ruptured ectopic pregnancy.
  2. It is found in 20% of patients with acute pancreatitis.
  3. Hemoperitoneum may lead to diffusion of blood along fascial planes to the periumbilical tissues, resulting in Cullen’s sign.
  4. Patients with Cullen’s sign may also have Grey-Turner’s sign, or flank ecchymosis.
  5. Patients with both Cullen’s sign and trauma should be evaluated for the presence of significant intraabdominal injury.
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3. All of the following conditions are associated with a positive Cullen’s sign EXCEPT:
  1. Hemorrhagic pancreatitis
  2. Splenic rupture
  3. Aortic rupture
  4. Crohn’s disease
  5. Hepatic malignancy
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4. Other conditions that may mimic Cullen’s sign include all of the following except:

  1. Periumbilical cellulitis
  2. Reaction to abdominal subcutaneous heparin injection
  3. Psoriasis involving the umbilicus
  4. Endometriosis with umbilical involvement
  5. Umbilical hernia
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