Kehr's sign

Q: 24 years old male is admitted to ICU after Motor Vehicle Accident (MVA). Trauma surgeon's note reads: "Positive Kehr's sign": What is Kehr's sign?

Answer: 

Kehr's sign is mostly pertinent in splenic rupture. Patient complains of left upper abdominal, left chest wall, and/or left shoulder pain that worsens with inspiration. The blood adjacent to the left hemidiaphragm irritates the phrenic nerve and exacerbates with inspiration. This can also be demonstrated by raising the legs while patient is in a supine position. 

Although known for many decades (see reference #1), and easy to perform, it frequently gets neglected during the initial evaluation.

#physical-exam

#trauma

#GI

Reference:

Lowenfels AB. Kehr's sign--a neglected aid in rupture of the spleen. N Engl J Med. 1966 May 5;274(18):1019. doi: 10.1056/NEJM196605052741810. PMID: 5909736.

Rastogi V, Singh D, Tekiner H, Ye F, Mazza JJ, Yale SH. Abdominal Physical Signs of Inspection and Medical Eponyms. Clin Med Res. 2019;17(3-4):115-126. doi:10.3121/cmr.2019.1420