Rupture of the spleen in infectious mononucleosis: a critical review.

Spontaneous rupture of the spleen in infectious mononucleosis is a well-known clinical phenomenon. However, when strict criteria concerning the presence or absence of trauma and the diagnosis of infectious mononucleosis are applied to the 107 cases in the world literature, only 18 true spontaneous ruptures are found. In these, the survival rate was 100%. In addition to pain referral to the left shoulder (Kehr's sign), right shoulder and scapular pain from diaphragmatic irritation, caused by free intraperitoneal blood, can be a valuable sign in determining splenic rupture. Because the spleen remains susceptible to rupture even after recovery based on all clinical, hematologic, and serological criteria, it is recommended that full normal activities not be resumed for two to three months by the nonathlete and for six months by the athlete.