Physical examination maneuver

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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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

Showing all 1 finding

Splenomegaly

Dullness on percussion over the spleen (Castell method)
Rule in
Somewhat helpfulWide CI
Rule out
Not helpfulDerived CI
Evidence:Moderate

Related Bedside Tests

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Spleen Palpation
Rule in:VHSplenomegaly, HMalaria, SHCirrhosis +13 more
Rule out:SHMyelofibrosis, MHInfectious Mononucleosis, MHSplenomegaly +13 more
🎬Video coming soon
Traube Space Spleen Percussion
Rule in:SHSplenomegaly
Rule out:MHSplenomegaly
🎬Video coming soon
Abdomen Palpation
Rule in:VHExtrahepatic Biliary Obstruction, VHIntussusception, VHPyloric Stenosis +32 more
Rule out:VHHepatocellular Jaundice, HAppendicitis, SHDiverticulitis +32 more
🎬Video coming soon
Abdomen Auscultation
Rule in:VHRenovascular Hypertension, MHBowel Obstruction, IEAbdominal Aortic Aneurysm +9 more
Rule out:MHRenovascular Hypertension, NHBowel Obstruction, IEAbdominal Aortic Aneurysm +9 more
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Abdomen Inspection
Rule in:VHBowel Obstruction, SHAscites, ICCushing Syndrome +3 more
Rule out:SHAscites, SHBowel Obstruction, NHCushing Syndrome +3 more
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Abdomen Percussion
Rule in:SHAscites, NHHepatomegaly, IEPerforated Viscus +2 more
Rule out:SHAscites, NHHepatomegaly, IEPerforated Viscus +2 more

Related Systems / Regions

AbdomenHematologicImmunologic

Related Diagnoses

Splenomegaly

Related Chief Complaints

Abdominal DistensionAbdominal FullnessEarly SatietyIncidental FindingLeft Upper Quadrant Pain

References

  • Meng E, Baweja K, Weersink C, Ahluwalia M, Hopman WM, Mainland R, et al. Performance of Point-of-Care Ultrasound Versus Traditional Physical Examination for the Bedside Evaluation of Splenomegaly. Ultrasound Q. 2026;42(3):e00752. doi:10.1097/RUQ.0000000000000752. PMID: 42335308.
  • 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.