Inguinal ecchymosis, known as Stabler sign, is classically associated with retroperitoneal hemorrhage. However, imaging confirmation of the underlying mechanism is rarely demonstrated. We report a 33-year-old woman who developed progressive right inguinal ecchymosis one week after excisional surgery for fibrocystic breast nodules. Physical examination revealed extensive bruising over the right breast and a separate ecchymotic area in the right inguinal region. Laboratory tests showed mild anemia with stable hemoglobin levels, while coagulation parameters and pancreatic enzymes were normal. Contrast-enhanced computed tomography excluded retroperitoneal or pelvic hemorrhage but revealed a large right breast hematoma. Multiplanar CT reconstructions demonstrated hyperattenuating fluid tracking along the superficial fascial planes of the anterior chest wall and abdominal wall toward the inguinal region. Anatomically, the superficial fascial system comprising Camper’s and Scarpa’s fascia provides a potential pathway for gravity-dependent migration of extraperitoneal blood. This case suggests that inguinal ecchymosis may result from extraperitoneal blood tracking from a distant postoperative hematoma rather than retroperitoneal bleeding.
Chuah et al. (Wed,) studied this question.