1. Extensive ecchymoses following a fall
A 72-year-old man slipped and fell backward in the bathroom, hitting his head on the toilet seat; he suffered only minimal discomfort. The following day, he presented with mild back pain and extensive bruising.
Impressive ecchymoses extended from his left flank to his right flank, across the midline, where a tender mass was palpated. Swelling was visible from a distance at the L4 level; the 17 X 10-cm lesion was raised approximately 1.5 cm, with overlying black-blue ecchymoses. The patient was taking self-prescribed baby aspirin(Drug information on aspirin), 81 mg/d; vitamins C, E, and B12; and Ginkgo biloba, 400 mg/d.
Could the fall alone have caused this extensive bruise—or is something else involved?