Elderly man with periumbilical and lower extremity ecchymosis

Clinical introduction

A 91-year-old nursing home resident presented with sudden onset of ecchymosis over his bilateral lower limbs and periumbilical region 4 hours before arrival at the emergency department (figure 1). He had a history of atrial fibrillation, hypertension, right hemiparesis and motor aphasia due to an old cerebrovascular accident. Physical examination revealed bilateral non-palpable femoral, popliteal, dorsalis pedis and posterior tibial pulses, and cold bilateral lower extremities. He had a platelet count of 264 109/L and an international normalised ratio of 1.22.

Figure 1

Initial physical examination.

Question

What is the most likely diagnosis for this patient?

Retroperitoneal haemorrhage.

Acute aortic …

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