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to assess the size of the spleen percuss the left lower anterior chest wall in a lateral direction noting the extent of timpani if timpani is prominent laterally spleen enlargement is unlikely next check for a splenic percussion sign find the lowest interspace in the left anterior axillary line and percuss there if timpani is heard ask a patient to take a deep breath alright now let it out as you continue to perk us in the same place when spleen size is normal timpani usually persists and the sign is considered negative an enlarged spleen is then very unlikely when the spleen is enlarged timpani often changes to dullness this is a positive sign this sign may be falsely positive but it indicates careful palpation or itis you know if I can feel the spleen next palpate the spleen with your left hand docHub over and around the patient to support the left lower posterior rib cage and adjacent tissue you can place your right hand on the abdomen low enough to detect a large spleen and point y
