Improving Diagnostic Image: the inside outside

A 40-year-old man had a diagnosis of disseminated melanoma. The diagnosis was made after a surgical biopsy from an inguinal adenopathy. When he was going to be discharged he suffered a syncope. A blood test showed an hemoglobin level of 7,5 g/dl, coincident with abdominal pain.

A CAT-scan showed intraperitoneal high-density liquid compatible with hemoperitoneum. He received several packages of red-cell transfusion to achieve a safe hemoglobin level. A red-purple area on the trunk appeared during the evolution compatible with the one described in the  Gray-Turner syndrome, usually associated with intra,retroperitoneal or pancreatic bleeding.