A 32-year-old woman is brought to the emergency department due to "bruising." She has a chronic mental disability and lives in a group home. Care staff members accompanying the patient report that she fell 3 days ago but has not mentioned any pain. No signs of injury were noted until a large area of discoloration was seen at the upper arm during bathing. Past medical history is unremarkable, and the patient takes no medications. Vital signs are normal. Skin examination findings are shown in the image below. There is no associated warmth, and the patient shows no signs of discomfort during palpation of the affected area. Which of the following terms best describes this abnormality?

Question

A 32-year-old woman is brought to the emergency department due to "bruising."  She has a chronic mental disability and lives in a group home.  Care staff members accompanying the patient report that she fell 3 days ago but has not mentioned any pain.  No signs of injury were noted until a large area of discoloration was seen at the upper arm during bathing.  Past medical history is unremarkable, and the patient takes no medications.  Vital signs are normal.  Skin examination findings are shown in the image below.  There is no associated warmth, and the patient shows no signs of discomfort during palpation of the affected area.  Which of the following terms best describes this abnormality?

Quizplus · Accepted Answer

This patient has a large area of ecchymosis involving the upper extremity. Patients and caregivers often use the term "bruise" to describe a variety of hemorrhagic skin lesions. However, the specific visual appearance often gives clues to the etiology of the lesion. An ecchymosis is a cutaneous or subcutaneous collection of extravasated blood measuring at least 1 cm in diameter. Ecchymoses can arise superficially without a history of noticeable trauma, but they frequently indicate a deep hemorrhage (hematoma) due to bony fracture, ligamentous rupture, or muscular injury. These lesions do not blanch under pressure because the red blood cells are not contained within the vasculature. Ecchymoses often pass through an evolution of color change (blue or red to brown, green, and yellow), which can be used to estimate the age of the injury. This property is especially useful in cases of suspected abuse when other historical details are unknown or inconsistent. (Choice A) Angiomas are chronic vascular malformations that most commonly appear as soft, well-demarcated, red or blue nodules. Capillary hemangiomas are usually small and superficial whereas cavernous hemangiomas are usually larger and more likely to involve deeper structures. (Choice C) Lentigines are small tan or brown macules most often seen on the sun-exposed skin of a middle-aged or elderly person. (Choices D and E) Petechiae (<5 mm diameter) and purpura (5 mm to 1 cm) are cutaneous or subcutaneous collections of extravasated blood from small-vessel bleeding that are often associated with platelet dysfunction or capillary fragility. They occur most commonly in areas of increased venous pressure (eg, ankles, feet). Palpable purpura are an indicator of leukocytoclastic vasculitis. (Choice F) Telangiectasias are small, permanent dilations of superficial capillaries or venules. Telangiectasias will blanch under pressure and are commonly seen in aging, chronic solar damage, long-term glucocorticoid use, rosacea, and a variety of systemic disorders. Educational objective: Ecchymoses frequently indicate a deep hemorrhage (hematoma) due to bony fracture, ligamentous rupture, or muscular injury. They do not blanch under pressure as the red blood cells are not contained within the vasculature. Ecchymoses often pass through an evolution of color change (blue or red to brown, green, and yellow), which can be used to estimate the age of the injury.

A 32-Year-Old Woman Is Brought to the Emergency Department Due