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ImagesinClinicalMedicineCullensandGreyTurnersSignsinAcutePancreatitisXavierValette,DamienduCheyronNEnglJMed;7:e28A6-year-oldmanwithnohistoryofalcoholabusepresentedwithsudden,severeepigastricpain.Theserumlipaselevelwaselevated(Uperliter;normalrange,22to51Uperliter),afindingconsistentwithacutepancreatitis.Abdominalultrasonographyrevealedcholelithiasiswithoutevidenceofcholedocholithiasis.Thepatientreceivedsupportivecarewithfluidhydration,painmedication,andbowelrest.Hisconditiondeteriorated,andhewastransferredtotheintensivecareunit2daysafterhospitaladmission.Physicalexaminationatthetimeofthetransferrevealedjaundice,withanelevatedtotalserumbilirubinlevel(4.2mgperdeciliter[71μmolperliter];normalrange,0.06to0.99mgperdeciliter[1to17μmolperliter])andabdominaldistentionwithperiumbilicalecchymosis(Cullenssign)(PanelA)andecchymosisoftheflank(GreyTurnerssign)(PanelB).Thesediscolorationsarearesultofliberatedpancreaticenzymescausingthediffusionoffatnecrosisandinflammationwithretroperitonealorintraabdominalbleeding;thediffusionoccursfromtheretroperito-neumtotheumbilicusthroughtheroundligamentforCullenssignandfromtheretroperitoneumtothesubcutaneoustissuesoftheflanksforGreyTurnerssign.Thesesigns,althoughnotspecific,areassociatedwithsevereacutepancreatitisandhighmortality.Computedtomographyconfirmedthepresenceofnecrotizingpancreatitiswithseveralacuteperipancreaticfluidcollections(BalthazargradeE)andgallstonesinthegallbladder,withnocholedocholithiasis.Multiple-organ-systemfailuredeveloped,andthepatienteventuallydiedfrom北京中科白癜风医学研究院如何诊断白殿疯