I. General Considerations
- The spleen is not normally palpable in healthy individuals.
- It must be enlarged 2–3 times its normal size to become palpable.
- Examination is performed with the patient in supine or right lateral decubitus position.
II. Inspection
- Often unremarkable unless massive splenomegaly.
- May observe:
- Left-sided abdominal fullness or bulge
- Skin changes (rare)
- Signs of underlying disease: pallor (anemia), petechiae (hypersplenism), jaundice (hemolysis)
III. Palpation of the Spleen
Method:
- Patient supine, knees flexed to relax abdominal wall.
- Start palpation in right iliac fossa and move diagonally toward the left hypochondrium.
- Use two hands: left hand under the left lower ribs to lift the spleen forward, right hand palpates anteriorly.
- Ask patient to inhale deeply — spleen moves downward.
Features to Observe if Palpable:
NOTE: Differentiates spleen from kidney (which does not move with respiration and has no notch).
IV. Percussion of the Spleen
A. Traube’s Space Percussion:
- Located in left lower anterior chest wall.
- Normal: tympanic
- Dullness: suggests splenomegaly, left pleural effusion, or stomach fullness.
B. Castell’s Sign:
- Percuss 8th or 9th intercostal space on anterior axillary line.
- Tympanic → Normal
- Dullness on inspiration → Splenomegaly