II. PHYSICAL EXAM

How to Examine a Patient for the Presence of Splenomegaly

The examining physician should stand on the patient’s right side, with the patient lying on their back. The physician’s left hand may be placed under the patient’s left rib cage for support. Starting just above the left iliac bone, the physician should gently palpate the abdomen as the patient takes deep inspirations. Palpation continues, moving up the left side of the abdomen until the left lower rib cage is reached. The spleen edge may be felt moving down and touching the examiner’s fingertips during the inspiration. This maneuver can be repeated with the patient lying on their right side, using the same technique. Palpation should be gentle, since enlarged spleens may sometimes be tender and can sometimes rupture.

Traube’s space refers to the resonant area at the lower portion of the left rib cage that corresponds to the position of the stomach (usually tympanitic because it is filled with air). If this area is dull on percussion, it may indicate the presence of splenomegaly (as the enlarged, solid spleen, has moved down to fill Traube’s space and displaces the normally tympanitic stomach). The size of the spleen is usually described as being some number of centimeters below the left costal margin.