There are times when it is helpful to measure the spleen on assessment. The disease processes that can cause splenomegaly include mononucleosis, idiopathic thrombocytopenia, hemolytic anemia, HIV infection, parasitic infection, connective tissue disorders, cirrhosis, portal hypertension, and splenic infarction, to name a few. Methods for measurement include palpation and percussion (Castell’s sign).

Percussion

Percussion should be performed prior to palpation. Percuss the left anterior midaxillary line at the lowest intercostal space. This sound should be tympanic. Ask the patient to take a deep breath and percuss at peak inspiration. The sound should remain tympanic; dullness is a positive sign but is not completely reliable to assess splenomegaly.

Palpation

Palpation is performed by standing on the patient’s right side and reaching over with the left hand to support the rib cage. Place your right hand just below the costal margin, leaving enough room to detect an enlarged spleen, and depressing the hand inward and upward to locate the splenic edge. Once located, ask the patient to take a deep breath and note the contour of the splenic edge as the spleen descends to meet your fingertips. This procedure may be repeated with the patient positioned on the right side to facilitate locating the spleen by use of gravity.

Report splenomegaly to the provider for further evaluation and treatment.

Reference:  
Bickley, L. S., Szilagyi, P. G., Hoffman, R. M., & Soriano, R. P. (2021). Bate’s Guide to Physical Examination and History Taking (13th ed.). Wolters Kluwer Health: Philadelphia.

 

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