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November 22, 1976

Hepatic Friction Rub

Author Affiliations

Long Island Jewish-Hillside Medical Center New Hyde Park, NY

JAMA. 1976;236(21):2391. doi:10.1001/jama.1976.03270220013006

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To the Editor.—  Hepatic friction rubs have been described in patients with primary and secondary tumors of the liver, liver abscess, syphilitic hepatitis, gonococcal perihepatitis, and after biopsy. We have recently observed a loud hepatic friction rub in a 39-year-old woman with Behçet syndrome and erythroleukemia. This patient had massive hepatomegaly (25-cm span), with the liver edge felt at the level of the iliac crest. The liver was diffusely tender to palpation, and she had right upper quadrant pain associated with respiratory movements and general body movements. The spleen tip was felt at the umbilicus, but no rub was heard over the left abdomen.A friction rub was heard on the third day of her admission, well localized over the lateral aspect of the right lobe of the liver. This persisted until her death one week later. At autopsy, no fibrinous exudate was apparent on the liver surface and there