Two techniques may help you to detect splenomegaly, an enlarged spleen:
■ Percuss the left lower anterior chest wall between lung resonance above and Dullness, as shown on the follow-the costal margin (an area termed Traube's space). As you percuss along ing page, raises the question of the routes suggested by the arrows in the following figures, note the lat- splenomegaly. eral extent of tympany.
This is variable, but if tympany is prominent, especially laterally, splenomegaly is not likely. The dullness of a normal spleen is usually hidden within the dullness of other posterior tissues.
■ Check for a splenic percussion sign. Percuss the lowest interspace in the left anterior axillary line, as shown below. This area is usually tympanitic. Then ask the patient to take a deep breath, and percuss again. When spleen size is normal, the percussion note usually remains tympanitic.
Fluid or solids in the stomach or colon may also cause dullness in Traube's space.
A change in percussion note from tympany to dullness on inspiration suggests splenic enlargement. This is a positive splenic percussion sign.
Anterior axillary line
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