Grey Turner's Sign: Flank Discoloration
Grey Turner's sign refers to ecchymosis (bruising) or discoloration appearing on the flank area, which is a clinical indicator of retroperitoneal hemorrhage, most commonly associated with severe acute pancreatitis.
Clinical Significance and Etiology
Grey Turner's sign manifests as bluish-grey or reddish-brown discoloration on the flanks (lateral abdominal wall). This physical finding occurs when blood or pancreatic enzymes track through fascial planes to reach subcutaneous tissues.
Common Causes:
- Acute pancreatitis (especially necrotizing pancreatitis) - most classic association 1
- Retroperitoneal hemorrhage from various sources
- Ruptured abdominal aortic aneurysm
- Ruptured ectopic pregnancy
- Rectus abdominis muscle hematoma
- Perforated duodenal ulcer
- Biliary peritonitis
- Metastatic cancer 2
Anatomical Pathway
The development of Grey Turner's sign follows a specific anatomical route:
- Extravasated pancreatic enzymes or blood spread from the anterior pararenal space
- Fluid travels between the two leaves of the posterior renal fascia
- It then extends to the lateral edge of the quadratus lumborum muscle
- Finally reaching the flank wall, often through the lumbar triangle (an anatomical weak point) 1
Clinical Correlation
When observed, Grey Turner's sign has important clinical implications:
Prognostic value: Present in <1% of acute pancreatitis cases and suggests severe disease with higher mortality risk 2
Timing: Typically appears 24-48 hours after the onset of the primary condition
Differential diagnosis: While classically associated with pancreatitis, its presence should prompt consideration of other serious intra-abdominal pathologies 3
Related Clinical Signs
Grey Turner's sign often appears alongside other ecchymotic findings:
Cullen's sign: Periumbilical ecchymosis resulting from blood tracking through the falciform ligament from the gastrohepatic ligament 1
Fox's sign: Ecchymosis in the inguinal ligament region
Bryant's sign: Ecchymosis of the scrotum
Diagnostic Approach
When Grey Turner's sign is observed:
Imaging studies: CT with IV contrast is the preferred modality to identify the underlying cause and trace the fluid pathway 4
Laboratory assessment: Evaluate for:
- Elevated pancreatic enzymes (lipase, amylase)
- Signs of hemorrhage (falling hemoglobin)
- Inflammatory markers (CRP)
Clinical Implications
The presence of Grey Turner's sign should alert clinicians to:
- Potentially life-threatening intra-abdominal pathology
- Need for prompt and thorough investigation
- Possible need for intensive monitoring and care
Conclusion
Grey Turner's sign represents a valuable physical finding that can provide important diagnostic clues in patients with abdominal pathology. While most commonly associated with severe acute pancreatitis, its presence should trigger consideration of various causes of retroperitoneal hemorrhage or inflammation.