Computed tomographic diagnosis of splenic trauma presenting with kehr's sign (referred left shoulder pain)

Abstract

Acute, posttraumatic shoulder pain is most often due to direct injury to the shoulder girdle. Occasionally, it can be due to pain referred from injury elsewhere, such as in the diaphragmatic region. In the setting of left-sided thoracoabdominal trauma, left upper quadrant tenderness, and left shoulder pain, splenic injury should be strongly suspected. Kehr's sign, or referred left shoulder pain from splenic injury, is well described in the surgery literature but has not received similar attention in the radiology literature. This communication describes a patient injured in a bicycling accident whose chief complaint was severe left shoulder pain. Negative shoulder radiographs and an unremarkable shoulder physical examination sparked concern for a splenic injury referring pain to the left shoulder, and this was confirmed on abdominopelvic computed tomography.