In 1955, Byrd and Couch1reported a case of spontaneous rupture of the spleen with hemorrhagic left pleural effusion after pancreatitis. At laparotomy a huge hematoma had been found in the left upper quadrant of the abdomen. According to these authors, no previous similar case had been reported. In 1917, Turner2documented a case wherein splenic rupture, due to splenic infarct, was associated with hemorrhagic pleural effusion. In each instance, hemorrhagic left pleural effusion without previous injury to the thoracic cage was present. An aftermath of acute, or recurrent, pancreatitis is the formation of many perisplenic adhesions which pull on the relatively mobile spleen and produce a shearing effect; this results in tearing of the soft, friable splenic tissue. In the patient we are reporting occupation may have played an important role; his job required driving a delivery truck over rough roads and repeatedly jumping in and out