Which sign is classically associated with splenic rupture and should raise suspicion for referred left shoulder pain (Kehr sign)?

Which sign is classically associated with splenic rupture and should raise suspicion for referred left shoulder pain (Kehr sign)?

• A. Kehr sign
• B. Cullen sign
• C. Grey-Turner sign
• D. Rovsing sign

Answer: (A)

Kehr sign reflects diaphragmatic irritation from intraperitoneal blood, most classically from splenic rupture, causing referred pain to the left shoulder via the phrenic nerve (C3–5). This is a clue to intra-abdominal hemorrhage and splenic injury. For context, Cullen sign is periumbilical ecchymosis indicating intraperitoneal hemorrhage, Grey-Turner sign is flank ecchymosis indicating retroperitoneal hemorrhage, and Rovsing sign is RLQ pain with LLQ palpation seen in appendicitis.

Kehr sign reflects diaphragmatic irritation from intraperitoneal blood, most classically from splenic rupture, causing referred pain to the left shoulder via the phrenic nerve (C3–5). This is a clue to intra-abdominal hemorrhage and splenic injury. For context, Cullen sign is periumbilical ecchymosis indicating intraperitoneal hemorrhage, Grey-Turner sign is flank ecchymosis indicating retroperitoneal hemorrhage, and Rovsing sign is RLQ pain with LLQ palpation seen in appendicitis.