Measure the vertical span of liver dullness in the right midclavicular line. Starting at a level below the umbilicus (in an area of tympany, not dullness), lightly percuss upward toward the liver. Ascertain the lower border of liver dullness in the midclavicular line.
Next, identify the upper border of liver dullness in the midclavicular line. Lightly percuss from lung resonance down toward liver dullness. Gently displace a woman's breast as necessary to be sure that you start in a resonant The span of liver dullness is increased area. The course of percussion is shown below. when the liver is en|arged.
The span of liver dullness is decreased when the liver is small, or when free air is present below the diaphragm, as from a perforated hollow viscus. Serial observations may show a decreasing span of dullness with resolution of hepatitis or congestive heart failure or, less commonly, with progression of fulminant hepatitis.
Liver dullness may be displaced downward by the low diaphragm of chronic obstructive lung disease. Span, however, remains normal.
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