An ecchymosis is a subcutaneous spot of bleeding with diameter larger than 1 centimetre (0.39 in). It is similar to (and sometimes indistinguishable from) a hematoma, commonly called a bruise, though the terms are not interchangeable in careful usage.[1] Specifically, bruises are caused by trauma whereas ecchymoses, which are the same as the spots of purpura except larger, are not necessarily caused by trauma,[2] often being caused by pathophysiologic cell function, and some diseases such as Marburg virus disease.

A broader definition of ecchymosis[3][4] is the escape of blood into the tissues from ruptured blood vessels. The term also applies to the subcutaneous discoloration resulting from seepage of blood within the contused tissue.

Bilateral periorbital ecchymosis (raccoon eyes)
Bilateral periorbital ecchymosis, also known as "raccoon eyes". (Bruising around the eyes on both sides.)

Signs and symptoms

Hematomas can be subdivided by size. By definition, ecchymoses are 1 centimetre in size or larger, and are therefore larger than petechiae (less than 2 millimetres in diameter) or purpura (2 millimetres to 1 centimetre in diameter).[5] Ecchymoses also have a more diffuse border than other purpura.[6]


There are many causes of subcutaneous hematomas including ecchymoses. Coagulopathies such as Hemophilia A may cause ecchymosis formation in children.[7] The medication betamethasone can have the adverse effect of causing ecchymosis.[8]

Etymology and pronunciation

The word ecchymosis (/ˌɛkɪˈmoʊsɪs/; plural ecchymoses, /ˌɛkɪˈmoʊsiːs/), comes to English from New Latin, based on Greek ἐκχύμωσις ekchymōsis, from ἐκχυμοῦσθαι ekchymousthai "to extravasate blood", from ἐκ- ek- (elided to ἐ- e-) and χυμός chymos "juice".[9] Compare enchyma, "tissue infused with organic juice"; elaboration from chyme, the formative juice of tissues.

See also


  1. ^ "UCSF Purpura Module" (PDF).
  2. ^ "Easy Bruising Symptoms".
  3. ^ Merriam-Webster Dictionary.; accessed 1/2/2012
  4. ^ Gould, George M. The Practitioner's Medical Dictionary, P. Blakiston's Son & Co., 1916 et seq.; p. 311
  5. ^ Leung, AKC; Chan, KW (August 2001). "Evaluating the Child with Purpura". American Family Physician. 64 (3): 419–429.
  6. ^ "Case Based Pediatrics Chapter". Retrieved 2009-01-08.
  7. ^ Lee, AC (June 2008). "Bruises, blood coagulation tests and the battered child syndrome" (PDF). Singapore Medical Journal. 49 (6): 445–449. PMID 18581014.
  8. ^ "betamethasone" (PDF). F.A. Davis.
  9. ^ Merriam-Webster, Merriam-Webster's Collegiate Dictionary: "ecchymosis", Merriam-Webster.

External links

Acral necrosis

Acral necrosis is a symptom common in bubonic plague. The striking black discoloration of skin and tissue, primarily on the extremities ("acral"), is commonly thought to have given rise to the name "Black Death," associated both with the disease and the pandemic which occurred in the 14th century. The term in fact came from the figural sense of "black", that is ghastly, lugubrious or dreadful.Clotting and bleeding beneath the skin cause an area of hemorrhage, the presence of red blood cells lying outside of capillaries, into the skin and subcutaneous tissue. In isolation, this is called an ecchymosis or bruise and may be the result of injury or illness. However, acral necrosis occurs when blood supply is disrupted for prolonged periods, blackening and damaging the affected area and surrounding tissue. With appropriate medical treatment, areas with acral necrosis may be successfully restored to function and lead a normal life. Untreated cases can lead to death.

Battle's sign

Battle's sign, also known as mastoid ecchymosis, is an indication of fracture of middle cranial fossa of the skull. These fractures may be associated with underlying brain trauma. Battle's sign consists of bruising over the mastoid process as a result of extravasation of blood along the path of the posterior auricular artery. The sign is named after William Henry Battle.Battle's sign takes at least one day to appear after the initial traumatic basilar skull fracture, similar to raccoon eyes. It is usually seen after head injuries resulting in injury to mastoid process leading to bruising.

Battle's sign may be confused with a spreading hematoma from a fracture of the mandibular condyle, which is a less serious injury.

Breast hematoma

Breast hematoma is a collection of blood within the breast. It arises from internal bleeding (hemorrhage) and may arise due to trauma (breast injury or surgery) or due to a non-traumatic cause.


A bruise, also known as a contusion, is a type of hematoma of tissue in which capillaries are damaged by trauma, causing a localized internal bleeding that extravasate into the surrounding interstitial tissues. Most bruises are not very deep under the skin so that the bleeding causes a visible discoloration. The bruise then remains visible until the blood is either absorbed by tissues or cleared by immune system action. Bruises, which do not blanch under pressure, can involve capillaries at the level of skin, subcutaneous tissue, muscle, or bone. Bruises are not to be confused with other similar-looking lesions primarily distinguished by their diameter or causation. These lesions include petechia (< 3 mm result from numerous and diverse etiologies such as adverse reactions from medications such as warfarin, straining, asphyxiation, platelet disorders and diseases such as cytomegalovirus), purpura (3 mm to 1 cm, classified as palpable purpura or non-palpable purpura and indicates various pathologic conditions such as thrombocytopenia), and ecchymosis (>1 cm caused by blood dissecting through tissue planes and settled in an area remote from the site of trauma or pathology such as periorbital ecchymosis, e.g.,"raccoon eyes", arising from a basilar skull fracture or from a neuroblastoma).As a type of hematoma, a bruise is always caused by internal bleeding into the interstitial tissues which does not break through the skin, usually initiated by blunt trauma, which causes damage through physical compression and deceleration forces. Trauma sufficient to cause bruising can occur from a wide variety of situations including accidents, falls, and surgeries. Disease states such as insufficient or malfunctioning platelets, other coagulation deficiencies, or vascular disorders, such as venous blockage associated with severe allergies can lead to the formation of purpura which is not to be confused with trauma-related bruising/contusion. If the trauma is sufficient to break the skin and allow blood to escape the interstitial tissues, the injury is not a bruise but bleeding, a different variety of hemorrhage. Such injuries may be accompanied by bruising elsewhere.

Bruise (disambiguation)

A bruise is a type of hematoma caused by trauma.

Bruise or Bruises may also refer to:

Bruise (album), by Assemblage 23, released 2012

"Bruises" (Chairlift song), released 2008

"Bruises" (Lewis Capaldi song), released 2017

"Bruises" (Train song), released 2012

Enoxaparin sodium

Enoxaparin sodium is an anticoagulant medication (blood thinner). It is used to treat and prevent deep vein thrombosis (DVT) and pulmonary embolism (PE) including during pregnancy and following certain types of surgery. It is also used in those with acute coronary syndrome (ACS) and heart attacks. It is given by injection just under the skin or into a vein. Other uses include inside kidney dialysis machines.Common side effects include bleeding, fever, and swelling of the legs. Bleeding may be serious especially in those who are undergoing a spinal tap. Use during pregnancy appears to be safe for the baby. Enoxaparin is in the low molecular weight heparin family of medications.Enoxaparin was first made in 1981 and approved for medical use in 1993. It is on the World Health Organization's List of Essential Medicines, the most effective and safe medicines needed in a health system. Enoxaparin is sold under several brand names and is available as a generic medication. The wholesale cost in the developing world is about US$1.90–10.80 per day. In the United States the wholesale cost is about $14.13 per day as of 2016. Enoxaparin is made from heparin. In 2016 it was the 295th most prescribed medication in the United States with more than a million prescriptions.

Fibular collateral ligament

The fibular collateral ligament (long external lateral ligament or lateral collateral ligament, LCL) is a ligament located on the lateral (outer) side of the knee, and thus belongs to the extrinsic knee ligaments and posterolateral corner of the knee.


A hematoma (US spelling) or haematoma (UK spelling) is a localized bleeding outside of blood vessels, due to either disease or trauma including injury or surgery and may involve blood continuing to seep from broken capillaries. A hematoma is benign and is initially in liquid form spread among the tissues including in sacs between tissues where it may coagulate and solidify before blood is reabsorbed into blood vessels. An ecchymosis is a hematoma of the skin larger than 10mm.They may occur among/within many areas such as skin and other organs, connective tissues, bone, joints and muscle.

A collection of blood (or even a hemorrhage) may be aggravated by anticoagulant medication (blood thinner). Blood seepage and collection of blood may occur if heparin is given via an intramuscular route; to avoid this, heparin must be given intravenously or subcutaneously.

It is not to be confused with hemangioma, which is an abnormal buildup/growth of blood vessels in the skin or internal organs.

Le Fort fracture of skull

A Le Fort fracture of the skull is a classic transfacial fracture of the midface, involving the maxillary bone and surrounding structures in either a horizontal, pyramidal or transverse direction. The hallmark of Lefort fractures is traumatic pterygomaxillary separation, which signifies fractures between the pterygoid plates, horseshoe shaped bony protuberances which extend from the inferior margin of the maxilla, and the maxillary sinuses. Continuity of this structure is a keystone for stability of the midface, involvement of which impacts surgical management of trauma victims, as it requires fixation to a horizontal bar of the frontal bone. The pterygoid plates lie posterior to the upper dental row, or alveolar ridge, when viewing the face from an anterior view. The fractures are named after French surgeon René Le Fort (1869–1951), who discovered the fracture patterns by examining crush injuries in cadavers.

List of eponymously named medical signs

Eponymous medical signs are those that are named after a person or persons, usually the physicians who first described them, but occasionally named after a famous patient. This list includes other eponymous entities of diagnostic significance; i.e. tests, reflexes, etc.

Numerous additional signs can be found for Graves disease under Graves' ophthalmopathy.

List of side effects of buspirone

Side effects of buspirone by incidence include:Very common (>10% incidence)



Somnolence (sleepiness)Common (1–10% incidence)

Uncommon (0.1–1%)

Rare (<0.1% incidence)

Ludwig Grünwald

Ludwig Grünwald (10 February 1863, Vienna – 11 August 1927) was an Austrian born, German internist and otolaryngologist.

He studied medicine in Munich, where after graduation, he opened a practice in internal medicine. He became a specialist in the field of otorhinolaryngology, being credited as the first physician to attempt surgery for the treatment of nasal suppuration and disease associated with the ethmoid and sphenoid bones.Along with internist Richard May (1863-1936), he developed a solution that later became known as the May–Grünwald stain, a stain used for peripheral blood film and bone marrow. His books on diseases of the larynx and on nasal suppuration have been translated into English.Aside from otolaryngology, he is also remembered for his discovery of a large ecchymosis located in the umbilicus associated with acute pancreatitis, the Grünwald's sign.


A petechia is a small (1–2 mm) red or purple spot on the skin, caused by a minor bleed from broken capillary blood vessels.Petechia refers to one of the three descriptive types of bleeding into the skin differentiated by size, the other two being purpura and ecchymosis. Petechiae are by definition less than 3 mm.

The term is almost always used in the plural, since a single lesion is seldom noticed or significant.

Raccoon eyes

Raccoon eyes (also known in the United Kingdom and Ireland as panda eyes) or periorbital ecchymosis is a sign of basal skull fracture or subgaleal hematoma, a craniotomy that ruptured the meninges, or (rarely) certain cancers. Bilateral hemorrhage occurs when damage at the time of a facial fracture tears the meninges and causes the venous sinuses to bleed into the arachnoid villi and the cranial sinuses. In lay terms, blood from skull fracture seeps into the soft tissue around the eyes. Raccoon eyes may be accompanied by Battle's sign, an ecchymosis behind the ear. These signs may be the only sign of a skull fracture, as it may not show on an X-ray. They may not appear until up to two hours after the injury. It is recommended that the patient not blow their nose, cough vigorously, or strain to prevent further tearing of the meninges.Raccoon eyes may be bilateral or unilateral. If bilateral, it is highly suggestive of basilar skull fracture, with a positive predictive value of 85%. They are most often associated with fractures of the anterior cranial fossa.Raccoon eyes may also be a sign of disseminated neuroblastoma or of amyloidosis (multiple myeloma). It also can be temporary result of rhinoplasty.

Depending on cause, raccoon eyes always require urgent consultation and management, that is surgical (facial fracture or post-craniotomy) or medical (neuroblastoma or amyloidosis).

Seat belt syndrome

Seat belt syndrome is a collective term that includes all injury profiles associated with the use of seat belts. It is defined classically as a seat belt sign (seat belt marks on the body) plus an intra-abdominal organ injury (e.g. bowel perforations) and/or thoraco-lumbar vertebral fractures. The seat-belt sign was originally described by Garrett and Braunstein in 1962 as linear ecchymosis of the abdominal wall following a motor vehicle accident. It is indicative of an internal injury in as many as 30% of cases seen in the emergency department. Disruption of the abdominal wall musculature can also occur but is relatively uncommon.

Skeletal survey

A skeletal survey (also called a bone survey) is a series of X-rays of all the bones in the body, or at least the axial skeleton and the large cortical bones. A very common use is the diagnosis of multiple myeloma, where tumour deposits appear as "punched-out" lesions. The standard set of X-rays for a skeletal survey includes X-rays of the skull, entire spine, pelvis, ribs, both humeri and femora (proximal long bones). It is more effective than isotope scans at detecting bone involvement in multiple myeloma. Although significantly less sensitive than MRI, it is easier to include more bones. A study found that MRI of just the spine and pelvis would have detected 9% fewer cases of bone involvement than the more extensive skeletal survey which therefore remains the standard method.Skeletal surveys are also used with suspected non-accidental injury in children (CE guidelines state that 19 images of the child are taken.) These are reported on by a consultant paediatric radiologist and often copies are made. Non-accidental injury is suspected if a child sustains an injury where the clinical findings are not consistent with the explanation given for the injury, such as a spiral fracture in a child who is not yet walking.

A skull CT is also done in connection with the radiographs if the child is under one year old or, if the child is older, where there is a clinical requirement (perioribtal ecchymosis, for example) as to rule out abusive head trauma.

The results of a skeletal survey may be used in a court of law as evidence of child abuse.

Skin popping

Skin popping is a route of administration of street drugs where they are injected or deposited under the skin. It is usually a depot injection, either subcutaneous or intradermal, and not an intramuscular injection. After deposition, the drug then diffuses slowly from the depot into the capillary networks, where it enters circulation. Skin popping is distinct from intravenous injection in that the latter deposits the drug directly into the bloodstream via a vein. Higher-potency prescription opioids, such as morphine, fentanyl, or meperidine can be injected subcutaneously, as can cocaine. Skin popping increases the duration of the high one gets from drugs such as cocaine. The sites where skin popping with cocaine has been performed have an area of central pallor surrounded by bruising (ecchymosis). This pattern is due to the vasoconstrictive properties of cocaine acting locally at the injection site with hemorrhage occurring in the surrounding tissue. Skin popping puts one at risk for developing secondary amyloid associated (AA) amyloidosis. Tetanus has also been associated with skin-popping as has botulism.

Skull fracture

A skull fracture is a break in one or more of the eight bones that form the cranial portion of the skull, usually occurring as a result of blunt force trauma. If the force of the impact is excessive, the bone may fracture at or near the site of the impact and cause damage to the underlying structures within the skull such as the membranes, blood vessels, and brain.

While an uncomplicated skull fracture can occur without associated physical or neurological damage and is in itself usually not clinically significant, a fracture in healthy bone indicates that a substantial amount of force has been applied and increases the possibility of associated injury. Any significant blow to the head results in a concussion, with or without loss of consciousness.

A fracture in conjunction with an overlying laceration that tears the epidermis and the meninges, or runs through the paranasal sinuses and the middle ear structures, bringing the outside environment into contact with the cranial cavity is called a compound fracture. Compound fractures can either be clean or contaminated.

There are four major types of skull fractures: linear, depressed, diastatic, and basilar. Linear fractures are the most common, and usually require no intervention for the fracture itself. Depressed fractures are usually comminuted, with broken portions of bone displaced inward—and may require surgical intervention to repair underlying tissue damage. Diastatic fractures widen the sutures of the skull and usually affect children under three. Basilar fractures are in the bones at the base of the skull.

Zygomaticomaxillary complex fracture

The zygomaticomaxillary complex fracture, also known as a quadripod fracture, quadramalar fracture, and formerly referred to as a tripod fracture or trimalar fracture, has four components: the lateral orbital wall (at either the zygomaticofrontal suture superiorly along the wall or zygomaticosphenoid suture inferiorly), separation of the maxilla and zygoma along the anterior maxilla (near the zygomaticomaxillary suture), the zygomatic arch, and the orbital floor near the infraorbital canal.

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