Case Report

By Dr. Antonio Manenti , Dr. Chiara Dal Molin , Dr. Lidia Amara
Corresponding Author Dr. Antonio Manenti
Department Surgery, - Italy
Submitting Author Dr. Antonio Manenti
Other Authors Dr. Chiara Dal Molin
Institute of Radiology - University of Modena.Italy, - Italy 41124

Dr. Lidia Amara
Institute of Radiology - University of Modena. Italy, - Italy 41124


Acute Pancreatitis, Computed Tomography, Grey-Turner's Sign

Manenti A, Dal Molin C, Amara L. Grey-Turner's Sign Radiological Equivalent at Computed Tomography in Acute Pancreatitis. WebmedCentral RADIOLOGY 2011;2(4):WMC001871
doi: 10.9754/journal.wmc.2011.001871
Submitted on: 14 Apr 2011 10:11:46 AM GMT
Published on: 16 Apr 2011 12:41:45 PM GMT


In case of acute pancreatitis, the radiological equivalent of Grey-Turner’s sign, even in absence of its clinical appearance, can be detected by Computed Tomography (CT) as a necrotico -hemorrhagic collection in the subcutaneous space of the flank. It is correlated with a high severity of the disease.


Subcutaneous ecchymosis, referred as Grey-Turner’s sign,  in the flank and Cullen’s in the periumbilical region, although pathognomonic , are seldom  observed  at the clinical examination in case of acute pancreatitis (1). In   particular,  it is admitted  that the Grey-Turner’s sign  follows a hemorrhagic collection, rich in pancreatic enzymes, in the anterior pararenal  space, while the

corresponding Cullen’s sign is secondary to  tracking of fluids  of pancreatic origin  through the gastro-hepatic and falciform ligaments towards the navel (2).  These signs indicate  the severity of  the disease.

A case , in which the Grey-Turner’s sign  was absent  at the clinical examination during the entire course of the disease, although  it could be clearly  recognized  by helicalCT, has been observed and reported later.

Case Report(s)

An obese Italian  woman 90 years old, 3 days after  an excessively abundant meal, was admitted  with severe signs  of acute pancreatitis (APACHE II score=15). Both the Grey-Turner’s and Cullen’s signs were absent at the clinical examination  on admission and also subsequently.   A helical CT  demonstrated only  a swollen pancreas, but   with fluid collections  extending outside  its capsule towards the retroperitoneum, especially on the left side,in the  anterior perirenal space, the paracolic gutter and in  the flank, where a large area of increased density  could be observed. Fluid around the liver and  the spleen, in the lesser cavity  and in the Douglas pouch was present.   Besides, it was found  a bilateral pleural effusion, more evident on the left side. (Illustration 1 ).

Five  days after,  a laparotomy confirmed  a severe  pancreatitis , with necrosis and fluid collections inside and outside the pancreatic capsule, extending in the retroperitoneum  especially towards the left flank.

A second helical CT ,  ten days from the admission,  clearly showed a diffuse necrosis  of the entire pancreatic gland, with necrotic fluid collections  extending outside,  in the lesser sac, and always  towards the left flank  with a persistent large subcutaneous  hyperdense infiltration (Illustration 2).

The patient died in the 15th post operative day  because of multiple organ failure.


Our observation confirms the great value of CT for the diagnosis and staging of acute pancreatitis, demonstrating also the  possible early  extrapancreatic  extension of the necrosis (3,4,5,6,7).  For this purpose ,  we think that the precocious  recognition  of the radiological equivalent of the Grey-Turner ‘s sign is useful , even in absence of cutaneous signs  and especially at the beginning of the disease,  when,  the pancreatic gland can demonstrate only edematous lesions.


1. Fox J.A. A diagnostic sign of extraperitoneal haemorrhage Br J Surg 1966; 53:193-95.
2. Bem J., Bradley E.L. Subcutaneous manifestations of severe acute pancreatitis. Pancreas  1988;16: 551-5.
3. Meyers M.A.,Feldberg M.A., Oliphant M. Grey-Turner’s sign and Cullen’s sign in acute pancreatitis. Gastrointest Radiol 1989; 14:31-7.
4. Sugimoto M.,Takada  T., Yasuda  H., Nagashima I. et al. MPR-hCT imaging  of pancreatic fluid pathway to Grey-Turner’s and Cullen’s sign in acute pancreatitis. Hepatogastroenterology 2005; 52:1613-6.
5. De Waele J.J.,Delrue L., Hoste  E.A., DE Vos M.  et al. Extrapancreatic inflammation  on abdominal computed tomography  as an arly predictor  of disease severity  in acute pancreatitis. Evaluation and  a new scoring system.  Pancreas 2007 ;2: 185-90.
6. Delrue L.J.,De Waele J.J., Doyck Ph.O. Acute panceatitis: radiological scorse in predicting severity and outcome. Abdom. Imaging 2010; 35 : 349-61.
7. Morgan D.E. Imaging of acute pancreatituis and its complications.Clin.Gastroeneterol.Hepatol.2008;6:1077-85.

Source(s) of Funding


Competing Interests



This article has been downloaded from WebmedCentral. With our unique author driven post publication peer review, contents posted on this web portal do not undergo any prepublication peer or editorial review. It is completely the responsibility of the authors to ensure not only scientific and ethical standards of the manuscript but also its grammatical accuracy. Authors must ensure that they obtain all the necessary permissions before submitting any information that requires obtaining a consent or approval from a third party. Authors should also ensure not to submit any information which they do not have the copyright of or of which they have transferred the copyrights to a third party.
Contents on WebmedCentral are purely for biomedical researchers and scientists. They are not meant to cater to the needs of an individual patient. The web portal or any content(s) therein is neither designed to support, nor replace, the relationship that exists between a patient/site visitor and his/her physician. Your use of the WebmedCentral site and its contents is entirely at your own risk. We do not take any responsibility for any harm that you may suffer or inflict on a third person by following the contents of this website.

0 comments posted so far

Please use this functionality to flag objectionable, inappropriate, inaccurate, and offensive content to WebmedCentral Team and the authors.


Author Comments
0 comments posted so far


What is article Popularity?

Article popularity is calculated by considering the scores: age of the article
Popularity = (P - 1) / (T + 2)^1.5
P : points is the sum of individual scores, which includes article Views, Downloads, Reviews, Comments and their weightage

Scores   Weightage
Views Points X 1
Download Points X 2
Comment Points X 5
Review Points X 10
Points= sum(Views Points + Download Points + Comment Points + Review Points)
T : time since submission in hours.
P is subtracted by 1 to negate submitter's vote.
Age factor is (time since submission in hours plus two) to the power of 1.5.factor.

How Article Quality Works?

For each article Authors/Readers, Reviewers and WMC Editors can review/rate the articles. These ratings are used to determine Feedback Scores.

In most cases, article receive ratings in the range of 0 to 10. We calculate average of all the ratings and consider it as article quality.

Quality=Average(Authors/Readers Ratings + Reviewers Ratings + WMC Editor Ratings)