Physical Exam

Spleen Palpation

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Video coming September 2026

How to Perform

With the patient supine, stand at the right side and reach across with your left hand to support and gently lift the lower left rib cage from behind. Place your right hand flat below the left costal margin, press in and upward, and ask the patient to take a deep breath, feeling for the splenic tip to descend against your fingers on inspiration. If nothing is felt, repeat with the patient in the right lateral decubitus position.

How to Interpret

Cirrhosis

Palpable spleen tip

Rule in

Somewhat helpful

Rule out

—

Evidence:Strong

Infectious Mononucleosis

Palpable spleen tip in an adolescent or young adult

Rule in

Somewhat helpful

Rule out

Minimally helpful

Evidence:Strong

References

Grover SA, Barkun AN, Sackett DL. The rational clinical examination. Does this patient have splenomegaly? JAMA. 1993;270(18):2218-2221. PMID: 8411607.
Gibson PR, Gibson RN, Ditchfield MR, Donlan JD. Splenomegaly-an insensitive sign of portal hypertension. Aust N Z J Med. 1990;20(6):771-774. doi:10.1111/j.1445-5994.1990.tb00421.x. PMID: 2291725. Closest study: 111 patients all with established portal hypertension and no comparison group, so it yields only a detection rate, not sensitivity/specificity or a likelihood ratio.
Cai X, Ebell MH, Haines L. Accuracy of Signs, Symptoms, and Hematologic Parameters for the Diagnosis of Infectious Mononucleosis: A Systematic Review and Meta-Analysis. J Am Board Fam Med. 2021 Nov-Dec;34(6):1141-1156. doi:10.3122/jabfm.2021.06.210217. PMID 34772769. PROSPERO CRD42021246280. PRISMA + QUADAS-2; bivariate random-effects meta-analysis (mada/R) for findings reported by >=3 studies, single-study point estimates (Stata diagti) where only 1 study reported the operating characteristic. Open access at jabfm.org.
Udell JA, Wang CS, Tinmouth J, FitzGerald JM, Ayas NT, Simel DL, Schulzer M, Mak E, Yoshida EM. Does this patient with liver disease have cirrhosis? JAMA. 2012;307(8):832-842. doi:10.1001/jama.2012.186. PMID: 22357834.
McGee S. Evidence-Based Physical Diagnosis. 6th ed. Philadelphia, PA: Elsevier; 2025.