2 ways to evaluate the spleen

There are times when it is useful to measure the spleen throughout the evaluation. Disease processes that will cause splenomegaly include, but are usually not limited to, mononucleosis, idiopathic thrombocytopenia, hemolytic anemia, HIV infection, parasitic infection, connective tissue disorders, cirrhosis, portal hypertension, and splenic infarction. Measurement methods include palpation and percussion (Castell’s sign).

Drums

Percussion ought to be performed before palpation. Strike the left anterior midaxillary line at the bottom intercostal space. This sound ought to be tympanic. Ask the patient to take a deep breath and tap on maximum inhalation. The sound should remain tympanic; dementia is a positive sign but shouldn’t be completely reliable in assessing splenomegaly.

Palpation

Palpation is performed by standing on the patient’s right side and reaching with the left hand to support the chest. Place your right hand just under the rib margin, leaving enough room to feel the enlarged spleen, after which press your hand inward and upward to locate the spleen margin. Once situated, ask the patient to take a deep breath and observe the contour of the sting of the spleen because the spleen descends and contacts the fingertips. This procedure could also be repeated with the patient placed on the precise side to facilitate localization of the spleen by gravity.

Report splenomegaly to your doctor for further evaluation and treatment.

Bickley, L. S., Szilagyi, P. G., Hoffman, R. M., & Soriano, R. P. (2021). Bate’s guide to physical examination and interviewing (thirteenth ed.). Wolters Kluwer Health: Philadelphia.