Professional Documents
Culture Documents
Introduction: The purpose of both palpation and percussion of the spleen is to look for splenic
enlargement. Evaluation of splenomegaly is notoriously difficult and embarrassingly easy to
miss when present. In part this is because the spleen enlarges in the inferior anteromedial
direction, sometimes as far as the RLQ.
Palpation
Technique
Clinical Pearl: To better appreciate the spleen, have your patient lay on their right side and flex
their legs towards their body. In adults, a normal spleen cannot be palpated unless they are very
thin.
Percussion
Technique
With patient supine, percuss inferior to lung resonance to map out gastric
tympany (i.e. Traube’s Space).
o This area is variable; however, tympanic extending laterally makes
splenomegaly less likely.
o Dullness may indicate splenomegaly, solid gastric content, or colon
content.
Splenic Percussion Sign (Castell’s Sign): Percuss the most inferior interspace on
the left anterior axillary line (Castell’s Point). This is usually tympanic. Ask pt to
breath deeply.
o Remains tympanic on inspiration: Splenic Percussion Sign negative:
splenomegaly less likely.
o Shift from tympanic to dullness: Splenic Percussion Sign positive:
splenomegaly more likely.