Splenomegaly - Abdominal Examination

SP

Splenomegaly — Abdominal Examination

Concise and clinical findings with practical tips for examination and presentation.

Left upper quadrant

Bimanual palpation

Traube's space

Inspection

On inspection the patient may have a visible fullness of the left hypochondrium when the spleen is large. Note any signs of chronic disease such as pallor, jaundice, or lymphadenopathy. Abdominal contour may be normal or show mild left-sided bulge.

Palpation

Use the bimanual technique with the patient lying supine and the examiner standing to the right. Place your left hand behind the patient at the left lower rib cage and press gently upward while your right hand palpates below the left costal margin. Ask the patient to take a deep breath — a palpable organ edge that descends with inspiration indicates splenic enlargement.

Features to document

Location: left hypochondrium; Direction of enlargement: toward the midline/umbilicus; Size: estimate cm below costal margin.

Edge

Note edge: sharp or rounded, smooth or nodular.

Consistency

Soft (tender/inflammatory) vs firm (hematologic infiltrative) vs hard (possible malignancy).

Tenderness

Usually non-tender unless infarction or abscess.

Percussion

Percuss Traube's space (left 6th rib anteriorly to anterior axillary line and left costal margin). Dullness in this area suggests splenic enlargement. Perform percussion from the left anterior axillary line medially to detect splenic enlargement (percussion note shifts from tympany to dullness over an enlarged spleen).

Auscultation

Auscultation is usually unremarkable. Listen for a splenic rub or bruit if infarction or vascular flow is suspected. Bowel sounds are otherwise normal.

Special tests & differentiation

Differentiate spleen from the left kidney: the spleen descends with inspiration and is not ballotable; the kidney is ballotable and may have a smooth mass that moves with respiration but is typically higher and more vascular. A palpable mass that is dull to percussion and has a notched edge strongly suggests the spleen. Consider shifting percussion and ultrasound for confirmation.

Conclusion

Clinical findings consistent with splenomegaly: palpable organ in the left hypochondrium that descends with inspiration, dullness over Traube's space, and characteristic edge/consistency as described above. Grade the enlargement (see Tips) and proceed with hematologic and imaging workup.

Viva Summary (formal):

On abdominal examination the spleen is palpable in the left hypochondrium, descending with respiration; percussion of Traube's space is dull. These findings are consistent with splenomegaly. Further evaluation with CBC and abdominal ultrasound is recommended to determine etiology and extent.

Examination Tips (point form):

• Position the patient supine with slight head elevation and relaxed abdomen.
• Use bimanual palpation; stand on the patient's right to perform the maneuver comfortably.
• Ask patient to take a deep breath — a spleen will move caudally with inspiration.
• Differentiate from kidney: kidney is ballotable and usually not as far lateral; spleen edge often has a notch.
• Grade splenomegaly clinically: mild (palpable <2 cm below costal margin), moderate (2–5 cm), marked/massive (>5 cm).
• Common benign causes: infectious mononucleosis, malaria, portal hypertension (congestive).
• Common malignant causes: hematologic malignancies (CLL, CML, lymphoma) — look for firmness, nodularity, systemic signs.
• If uncertain, use ultrasound — it is sensitive and helps measure spleen dimensions and detect focal lesions.

Prepared for clinical rounds

Updated: Oct 2025