Physical Exam

Spleen Percussion

Castell method and Nixon method are two distinct percussion techniques performed at this station, not alternate names for one another or for the maneuver as a whole.

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Video coming September 2026

How to Perform

With the patient supine, percuss the lowest left intercostal space in the anterior axillary line at full expiration and again at full inspiration. A positive Castell sign is a change from resonance on expiration to dullness on inspiration.

How to Interpret

Splenomegaly

Dullness on percussion over the spleen (Castell or Nixon method)

Rule in

Somewhat helpfulDerived CI

Rule out

Somewhat helpfulDerived CI

Evidence:LimitedResearch in progress

References

Research in progress on one or more findings above; ratings may change.

Grover SA, Barkun AN, Sackett DL. The rational clinical examination. Does this patient have splenomegaly? JAMA. 1993;270(18):2218-2221. doi:10.1001/jama.1993.03510180088040. PMID 8411607. (Correction: JAMA. 2011;305(14):1414.)
Castell DO. The spleen percussion sign: a useful diagnostic technique. Ann Intern Med. 1967;67(6):1265-1267.
Nixon RK Jr. The detection of splenomegaly by percussion. N Engl J Med. 1954;250(4):166-167.

Research last updated September 10, 2026.