Cullen sign: superficial oedema with bruising in the subcutaneous fatty tissue around the peri-umbilical region. Originally described in association with ectopic pregnancy.
Cullen sign has been described in myriad clinical scenarios including acute pancreatitis; rectus sheath hematoma; massive ovarian enlargement; amoebic liver abscess; splenic rupture; perforated duodenal ulcer; metastatic thyroid cancer; intra-abdominal non-Hodgkin’s lymphoma and as a complication of anticoagulation.
Original publication: (n=1)
1918 – Thomas Stephen Cullen first described a bluish black discoloration of the periumbilical skin in a female patient with a ruptured extrauterine pregnancy with ‘no history of injury‘ – Cullen sign
He concluded that the umbilical appearance was due to intra-abdominal haemorrhage secondary to an ectopic pregnancy
He originally described the finding at the 43rd annual meeting of the Transactions of the American gyecological society, Pennsylvania May 16-18 1918 [Am J Obstet Gynecol 1918;78:457
TS Cullen original description
- John Henry Bryant and Bryant sign (1903)
- Thomas Stephen Cullen and Cullen sign (1918)
- George Grey Turner and Grey Turner sign (1919)
- Francis Edward Stabler and Stabler Sign (1934)
- John Adrian Fox and Fox sign (1966)
- Cullen’s sign
- Peri-umbilical ecchymosis
- The topographic location of the ecchymosis of Grey Turner and Cullen do not point to the aetiology with any degree of certainty.
- Cullen sign lacks sensitivity and specificity for its original description. It has been described in acute pancreatitis, rectus sheath hematoma, splenic rupture, perforated ulcer, intra-abdominal cancer, and ruptured ectopic pregnancy, and as a complication of anticoagulation [Am J Med. 2008]
- Cullen TS. A new sign in ruptured extrauterine pregnancy. Am J Obstet Gynecol 1918;78:457
- Chung KM, Chuang SS. Cullen and Grey Turner signs in idiopathic perirenal hemorrhage. CMAJ. 2011 Nov 8;183(16):E1221 [PMC3216450]
- Harris S, Naina HV. Cullen’s sign revisited. Am J Med. 2008 Aug;121(8):682-3. [PMID 18691478]
- Rahbour G, Ullah MR, Yassin N, Thomas GP. Cullen’s sign – Case report with a review of the literature. Int J Surg Case Rep. 2012; 3(5): 143–146. [PMC3312052]