Abstract
Assessing for the presence of splenomegaly is an important component of the physical examination. Although several methods of palpation and percussion of the spleen have been described, until recently they have not been validated by noninvasive imaging techniques such as ultrasonography, radionuclide scanning, and computed tomography that offer objective means to assess splenomegaly. We review the literature comparing various physical examination techniques with noninvasive imaging modalities and conclude that palpation and percussion of the spleen are complementary but frequently insensitive and that further studies are needed to evaluate the efficacy of specific diagnostic methods.
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Selected References
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- Arkles L. B., Gill G. D., Molan M. P. A palpable spleen is not necessarily enlarged or pathological. Med J Aust. 1986 Jul 7;145(1):15–17. doi: 10.5694/j.1326-5377.1986.tb113733.x. [DOI] [PubMed] [Google Scholar]
- BLACKBURN C. R. On the clinical detection of enlargement of the spleen. Australas Ann Med. 1953 May;2(1):78–80. doi: 10.1111/imj.1953.2.1.78. [DOI] [PubMed] [Google Scholar]
- BROGDON B. G., CROW N. E. Observations on the normal spleen. Radiology. 1959 Mar;72(3):412–414. doi: 10.1148/72.3.412. [DOI] [PubMed] [Google Scholar]
- Barkun A. N., Camus M., Meagher T., Green L., Coupal L., De Stempel J., Grover S. A. Splenic enlargement and Traube's space: how useful is percussion? Am J Med. 1989 Nov;87(5):562–566. doi: 10.1016/s0002-9343(89)80615-1. [DOI] [PubMed] [Google Scholar]
- Blendis L. M., McNeilly W. J., Sheppard L., Williams R., Laws J. W. Observer variation in the clinical and radiological assessment of hepatosplenomegaly. Br Med J. 1970 Mar 21;1(5698):727–730. doi: 10.1136/bmj.1.5698.727. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Breiman R. S., Beck J. W., Korobkin M., Glenny R., Akwari O. E., Heaston D. K., Moore A. V., Ram P. C. Volume determinations using computed tomography. AJR Am J Roentgenol. 1982 Feb;138(2):329–333. doi: 10.2214/ajr.138.2.329. [DOI] [PubMed] [Google Scholar]
- Castell D. O., O'Brien K. D., Muench H., Chalmers T. C. Eastimation of liver size by percussion in normal individuals. Ann Intern Med. 1969 Jun;70(6):1183–1189. doi: 10.7326/0003-4819-70-6-1183. [DOI] [PubMed] [Google Scholar]
- Castell D. O. The spleen percussion sign. A useful diagnostic technique. Ann Intern Med. 1967 Dec;67(6):1265–1267. doi: 10.7326/0003-4819-67-6-1265. [DOI] [PubMed] [Google Scholar]
- Cools L., Osteaux M., Divano L., Jeanmart L. Prediction of splenic volume by a simple CT measurement: a statistical study. J Comput Assist Tomogr. 1983 Jun;7(3):426–430. doi: 10.1097/00004728-198306000-00007. [DOI] [PubMed] [Google Scholar]
- Davis H. H., 2nd, Varki A., Heaton W. A., Siegel B. A. Detection of accessory spleens with indium 111-labeled autologous platelets. Am J Hematol. 1980;8(1):81–86. doi: 10.1002/ajh.2830080110. [DOI] [PubMed] [Google Scholar]
- DeLand F. H. Normal spleen size. Radiology. 1970 Dec;97(3):589–592. doi: 10.1148/97.3.589. [DOI] [PubMed] [Google Scholar]
- Eichner E. R. Splenic function: normal, too much and too little. Am J Med. 1979 Feb;66(2):311–320. doi: 10.1016/0002-9343(79)90554-0. [DOI] [PubMed] [Google Scholar]
- Groshar D., Israel O., Front D. Spleen imaging--enlargement of the spleen. Semin Nucl Med. 1983 Jul;13(3):295–297. doi: 10.1016/s0001-2998(83)80024-5. [DOI] [PubMed] [Google Scholar]
- HOLZBACH R. T., CLARK R. E., SHIPLEY R. A., KENT W. B., 3rd, LINDSAY G. E. Evaluation of spleen size by radioactive scanning. J Lab Clin Med. 1962 Dec;60:902–913. [PubMed] [Google Scholar]
- Halpern S., Coel M., Ashburn W., Alazraki N., Littenberg R., Hurwitz S., Green J. Correlation of liver and spleen size. Determinations by nuclear medicine studies and physical examination. Arch Intern Med. 1974 Jul;134(1):123–124. [PubMed] [Google Scholar]
- Heymsfield S. B., Fulenwider T., Nordlinger B., Barlow R., Sones P., Kutner M. Accurate measurement of liver, kidney, and spleen volume and mass by computerized axial tomography. Ann Intern Med. 1979 Feb;90(2):185–187. doi: 10.7326/0003-4819-90-2-185. [DOI] [PubMed] [Google Scholar]
- Kardel T., Holm H. H., Rasmussen S. N., Mortensen T. Ultrasonic determination of liver and spleem volumes. Scand J Clin Lab Invest. 1971 Apr;27(2):123–128. doi: 10.3109/00365517109080197. [DOI] [PubMed] [Google Scholar]
- Larson S. M., Tuell S. H., Moores K. D., Nelp W. B. Dimensions of the normal adult spleen scan and prediction of spleen weight. J Nucl Med. 1971 Mar;12(3):123–126. [PubMed] [Google Scholar]
- McIntyre O. R., Ebaugh F. G., Jr Palpable spleens in college freshmen. Ann Intern Med. 1967 Feb;66(2):301–306. doi: 10.7326/0003-4819-66-2-301. [DOI] [PubMed] [Google Scholar]
- NIXON R. K., Jr The detection of splenomegaly by percussion. N Engl J Med. 1954 Jan 28;250(4):166–167. doi: 10.1056/NEJM195401282500407. [DOI] [PubMed] [Google Scholar]
- Niederau C., Sonnenberg A., Müller J. E., Erckenbrecht J. F., Scholten T., Fritsch W. P. Sonographic measurements of the normal liver, spleen, pancreas, and portal vein. Radiology. 1983 Nov;149(2):537–540. doi: 10.1148/radiology.149.2.6622701. [DOI] [PubMed] [Google Scholar]
- Parrino T. A. The art and science of percussion. Hosp Pract (Off Ed) 1987 Sep 30;22(9A):25-8, 32-6. [PubMed] [Google Scholar]
- Pietri H., Boscaini M. Determination of a splenic volumetric index by ultrasonic scanning. J Ultrasound Med. 1984 Jan;3(1):19–23. doi: 10.7863/jum.1984.3.1.19. [DOI] [PubMed] [Google Scholar]
- ROSENBAUM H. D., LIEBER A., HANSON D. J., PELLEGRINO E. D. A ROUTINE SURVEY ROENTGENOGRAM OF THE ABDOMEN ON 500 CONSECUTIVE PATIENTS OVER 40 YEARS OF AGE. Am J Roentgenol Radium Ther Nucl Med. 1964 Apr;91:903–909. [PubMed] [Google Scholar]
- Rollo F. D., DeLand F. H. The determination of spleen mass from radionuclide images. Radiology. 1970 Dec;97(3):583–587. doi: 10.1148/97.3.583. [DOI] [PubMed] [Google Scholar]
- Strauss L. G., Clorius J. H., Frank T., van Kaick G. Single photon emission computerized tomography (SPECT) for estimates of liver and spleen volume. J Nucl Med. 1984 Jan;25(1):81–85. [PubMed] [Google Scholar]
- Sullivan S., Williams R. Reliability of clinical techniques for detecting splenic enlargement. Br Med J. 1976 Oct 30;2(6043):1043–1044. doi: 10.1136/bmj.2.6043.1043. [DOI] [PMC free article] [PubMed] [Google Scholar]
- WYMAN A. C. Traumatic rupture of the spleen. Am J Roentgenol Radium Ther Nucl Med. 1954 Jul;72(1):51–63. [PubMed] [Google Scholar]
- Whitley J. E., Maynard C. D., Rhyne A. L. A computer approach to the prediction of spleen weight from routine films. Radiology. 1966 Jan;86(1):73–76. doi: 10.1148/86.1.73. [DOI] [PubMed] [Google Scholar]
- Zhang B., Lewis S. M. A study of the reliability of clinical palpation of the spleen. Clin Lab Haematol. 1989;11(1):7–10. doi: 10.1111/j.1365-2257.1989.tb00168.x. [DOI] [PubMed] [Google Scholar]