Differential Diagnosis > Morphology > Reaction Patterns Expanded > Purpura > Non-Palpable Purpura

Non-Palpable Purpura

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<3mm = petechiae (thrombocytopenia)

>3mm = ecchymosis (fragile blood vessels)

 

 

Clinical Differential Diagnosis

•solar purpura
•Gardner-Diamond syndrome
•ecchymotic Ehlers-Danlos (type IV)
•vs. platelet disorder (see below)
•vs. loss of support tissue (see below)

 

•Cullen’s sign: purpura around the umbilicus
•Grey-Turner’s sign: purpura in the flank
hmtoggle_plus1these two physicals signs indicate:
•seen in acute hemorrhagic pancreatitis
•retroperitoneal blood can dissect along fascial planes into the skin of the flank, the abdominal wall, and around the umbilicus
•patients are acutely ill

 

 

Etiology Differential Diagnosis

hmtoggle_plus1Loss of support tissue:
•solar purpura
•steroid induced purpura (topical vs. systemic)
•lichen sclerosus et atrophicus
•amyloid
•scurvy
•histiocytosis X (?)

 

hmtoggle_plus1platelet disorder
•thrombocytopenia: immune ITP, meds, lupus(?), HIV(?) vs. non-immune meds (e.g. chemo), consumption (e.g. DIC), bone marrow failure (e.g. cancer)
•vs. platelet dysfunction liver disease, kidney disease, meds (e.g. aspririn)

 

increased hydrostatic pressure: Valsalva (e.g. vomitting, coughing), suction