Physical Exam

Spleen Percussion

also known as Castell sign; Nixon sign

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How to Perform

Two methods are used. In Castell's method, with the patient supine, percuss the lowest left intercostal space in the anterior axillary line during full expiration and again during full inspiration; the note is normally resonant and stays resonant, and a change from resonance to dullness on inspiration is the positive result. In Nixon's method, with the patient in the right lateral decubitus position, percuss upward from the midpoint of the left costal margin perpendicular to it; dullness extending more than about 8 cm above the costal margin is the positive result.

How to Interpret

This test’s findings are all below your current evidence filter.

References

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.