Clinical examination of the spleen

The spleen enlarges inferiorly and medially from the left costal margin across the umbilicus to the right iliac fossa.

Physical examination is by:

• palpation
• percussion - over the spleen, the percussion note is dull
• auscultation - rarely, revealing a friction rub

In differentiating the spleen from an enlarged left kidney or a mass at the splenic flexure, note that:

• the spleen has no palpable upper border
• the spleen is not ballottable except in the presence of gross ascites