What does this picture have to do with splenomegaly? Send me an email - if you're right, I'll buy you a coke. The spleen is the 3rd most underappreciated internal organ.
If you need a reminder on how to perform any of the maneuvers below, send me an email/page and we can go through it.
Does my patient have splenomegaly? Tough to say... this is not the most reliable exam, however if your pre-test probability is somewhat high (>10%), then the exam can be quite helpful.
Castell's Sign: The patient is supine. Locate the intersection between the left anterior axillary line (*note* not mid axillary line) and the last intercostal space. Perucuss. It should be resonant. When your patient breaths in and holds, this should stay resonant. If you hear dullness then voila - probably splenomegaly(Sensitivity 82%; Specificity 83%).
Palpation: Either use your hand, or the patients hand for counter-pressure in the left flank. Palpate from the RLQ diagonally up, inching incrementally as the patient exhales. Try rolling the patient into the right lateral decubitus if you do not feel anything and repeat your palpation(Sensitivity ~60%; Specificity ~90%). Feel for the splenic notch.
Middleton's Hooking Maneuver: Approach the patient from the left side, with the patient supine and their fist under the left costovertebral angle, hook your fingers under the left costal margin. Ask the patient to breath in, and feel for the spleen tip (sensitivity ~60%; Specificity ~90%).
Others: Nixon's percussion method is helpful, but Traube's space is pretty useless. I can show you these whenever you like.
Here is a link to the sentinel JAMA article on splenomegaly.
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