A site for medical students - Practical,Theory,Osce Notes

When do you search for splenic rub?

Splenic rub is heard in situations where the patient complains of acute pain in left upper quadrant of abdomen (often with radiation of pain to the tip of left shoulder) due to splenic infarction resulting in perisplenitis (with acute splenic tenderness)
It is produced in the following conditions like.
  • Subacute bacterial endocarditis
  • Chronic myeloid leukaemia.
  • Sickle cell anaemia.
  • After splenic puncture (eg. in diagnosis of chronic kala-azar).
Acute splenic tenderness indicates splenic infarction or abscess formation.
The characteristics of splenic rub are
  • It is a scratchy to-and-fro sound heard with respiration i.e. during movement of the spleen.
  • If the patient holds his breath, the rub stops.
  • The diaphragm of stethoscope should be placed over the spleen or left lower chest.
  • It should be always be differentiated from left sided pleural effussion(spleen is always tender in splenic rub
Treatment of splenic rub
  • Rest and analgesia. 
  • Repeated splenic infarction may be an indication for splenectomy.
Always auscultate for spelnic rub over a hugely enlarged spleen.
Spleen may be mildly lender in acute malaria, infectious mononucleosis. SBE and enteric fever.