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Figure 17-28 Another technique for splenic palpation, with patient lying on right side.

favorable position for palpation. The examiner places his or her left hand on the patient's left costal margin while the right hand palpates in the left upper quadrant. The technique is demonstrated in Figure 17-28.

Because the spleen enlarges diagonally in the abdomen from the left upper quadrant toward the umbilicus, the examiner's right hand should always palpate near the umbilicus and gradually move toward the left upper quadrant. This is particularly important if the spleen is massively enlarged, because starting the palpation too high may cause the examiner to miss the splenic border.

The spleen is not palpable in normal conditions, but both techniques should be used in an attempt to palpate it. Splenic enlargement may result from hyperplasia, congestion, infection, or infiltration by tumor or myeloid elements. Massive splenomegaly in a patient with chronic myelocytic leukemia is pictured in Figure 17-29.

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