Percussion of the spleen may not be supported by a solid scientific evidence but it may indicate splenomegaly, if NOT confirming it. The basic of the percussion examination of the spleen is demonstrated in the attached video. Step 1: With patient supine, percuss inferior to lung resonance to map out gastric tympany (i.e. Traube’s Space). This area is variable; however, tympanic extending laterally makes splenomegaly less likely. Dullness may indicate splenomegaly, solid gastric content, or colon content.
Step 2: 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 patient to breathe deeply. Remains tympanic on inspiration: Splenic Percussion Sign negative: splenomegaly less likely. Shift from tympanic to dullness: Splenic Percussion Sign positive: splenomegaly more likely.…
