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To assess spleen size, percussion is used on the left lower anterior chest wall in a lateral direction. If timpani is prominent, spleen enlargement is unlikely. The lowest interspace in the left anterior axillary line is then percussed for a splenic percussion sign. If timpani is heard, the patient is asked to take a deep breath and let it out while continuing to percuss. If the spleen size is normal, timpani usually persists, indicating a negative sign. However, if the spleen is enlarged, timpani may change to dullness, a positive sign that suggests careful palpation or itis. Palpation of the spleen is done with the left hand supporting the left lower posterior rib cage, while the right hand is placed low on the abdomen to detect a large spleen.
