What is Cullen sign associated with in a trauma context?

Cullen sign refers to a clinical finding characterized by a bluish discoloration around the umbilicus. In the context of trauma, the presence of Cullen sign is most commonly associated with retroperitoneal hemorrhage. This occurs when there is bleeding in the retroperitoneal space, which can result from various causes, including abdominal trauma, ruptured ectopic pregnancy, or bleeding from abdominal organs. The blood that accumulates in this space can migrate and manifest as discoloration around the belly button, thus indicating a potential internal bleeding event that warrants further evaluation.

In contrast to the other options, which may involve different types of injuries, Cullen sign specifically signals the possibility of significant internal bleeding, often necessitating imaging studies or surgical exploration to identify the source and manage the underlying condition.