A patient presents with fever.  After the history, you suspect leukemia.  Is there splenomegaly?


Percussion: The chest wall should be tympanitic at the costal margin of the anterior axillary line. Dullness is abnormal and is taken to indicate splenomegaly. This test is neither sensitive nor specific but it does have some value.


Palpation: Any palpation of the spleen is abnormal.  It is easiest to feel the edge as it ballots against the volar fingers.  Approach from the left or right lower quadrants and move inward. Place your left hand on the affected area and then place the right hand above it, balloting for the edge. This is more specific than dullness to percussion


Maneuvers to increase detection include putting the patient’s left hand behind the back  and rolling the patient onto the right side.  Obesity limits the examination.


Take home points:

Palpation of the splenic edge is the most specific sign of splenomegaly


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