Although the size of the spleen is often difficult to determine, evaluation of the spleen should begin with percussion of splenic size. In normal individuals, the spleen lies hidden within the rib cage against the posterolateral wall of the abdominal cavity in Traube's space. Traube's space is defined by the sixth rib superiorly, the left anterior axillary line laterally, and the costal margin inferiorly. As the spleen enlarges, it remains close to the abdominal wall, and the tip moves downward and toward the midline. Because the early enlargement is in an anteropos-terior direction, considerable enlargement may occur without its becoming palpable below the costal margin. It is thought that dullness to percussion in Traube's space—the loss of tympany from the air-filled colon and stomach because of the enlarged spleen—is a useful sign for determining splenic enlargement.
Have the patient lie in the supine position. With the patient breathing normally, percuss in the lowest intercostal space in the left anterior axillary line. Normal percussion yields either a resonant or tympanic note. A positive test of splenomegaly is diagnosed when the percussion note is dull. With ultrasonography, the standard imaging technique, splenic percussion has a sensitivity of 62% and a specificity of 72%. In leaner individuals who had not eaten in the previous 2 hours, the sensitivity was 78% and the specificity was 82%.
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