The clinical presentation of infarction may vary. They may be discovered incidentally on radiologic or postmortem studies, or hemorrhagic shock as a result of subcapsular haematoma with rupture into the peritoneal cavity.

Approximately one-third of splenic infarcts are clinically occult. The most common presenting symptom is left upper quadrant abdominal pain. Additional symptoms include fever and chills, nausea and vomiting, pleuritic chest pain, and left shoulder pain (Kehr’s sign). Septic thromboemboli can result in splenic abscesses, which present with sepsis and left upper quadrant abdominal pain.