The Stanford 25

An Initiative to Revive the Culture of Bedside Medicine

Examination of the Spleen

Introduction: 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.

Technique:

[Stanford 25 video forthcoming: see Bates video below.]

Palpation

  • “LET THE SPLEEN PALPATE YOUR FINGER AND NOT THE OTHER WAY AROUND. THERE IS NO GOLD, SO DON’T DIG.” Remember that the spleen can become very enlarged and fragile (e.g. in mononucleosis); overly aggressive palpation may cause injury.
    • Start in RLQ (so you don’t miss a giant spleen).
    • Get your fingers set then ask patient to take a deep breath. Don’t dip your fingers or do anything but wait.
    • When patient expires, take up new position.
  • If spleen is not felt, repeat with pt lying on right side. Gravity may bring spleen within reach.
    • NOTE: Dr. Rosenberg demonstrates a different technique in the lymph node exam.

Percussion: may indicate but does NOT confirm splenomegaly.

  • With pt supine, percuss inferior to lung resonance to map out gastric tympany (i.e. Traube’s Space).
    • This area is variable; however, tympany extending laterally makes splenomegaly less likely.
    • 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.
    • Remains tympanic on inspiration: Splenic Percussion Sign negative: splenomegaly less likely.
    • Shift from tympany to dullness: Splenic Percussion Sign positive: splenomegaly more likely.

Findings:

Note tenderness.

Measure spleen’s lowest point below costal margin.

Describe splenic contour.

Embedded Videos & Links (Not produced by Stanford, click through for credit and source).

Findings:

Thyroid Enlargement:

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Written by stanford25admin

June 7, 2010 at 3:34 pm

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