GetTheDiagnosis.org

Welcome, guest.
Login or Sign up to edit.

Add an entry

Search:
 

Tools

Add a finding for this diagnosis

Add prevalence for this diagnosis

Switch to calculator mode to see positive predictive value

Switch to sensitivity and specificity

Sort findings by Tag

Sort findings by Differential Diagnosis

Jump To

Good Positive and Negative Likelihood Ratios

Good Positive Likelihood Ratio

Poorly Diagnostic Findings

Splenomegaly: Likelihood Ratios

Introduction: Splenomegaly, an enlarged spleen, may be found in many diagnoses, including infectious mononucleosis, lymphoma, and cirrhosis. Generally accepted cutoffs for an enlarged spleen are >250g, 12-13cm in length, 7cm in width, or 250cc in volume (PMID 8411607).

[Edit Diagnosis] [Merge dx] [Add prevalence]

Tags: None. Tag this Diagnosis.

The likelihood ratios of findings for Splenomegaly are listed below. See the left navigation bar to change the display.

Good Positive and Negative Likelihood Ratios

Finding +LR-LR Comments, Study
Percussion
Duplicate Edit
4.80.2

Castell's method: The patient is placed in the supine position. Percussion is carried out in the lowest intercostal space in the left anterior axillary line in both expiration and full inspiration (Fig 4). In a normal examination, the percussion note re-mains resonant throughout this maneuver. Splenomegaly is diagnosed when the percussion note is dull or becomes dull on full inspiration.

Study: JAMA. 1993 Nov 10;270(18):2218-21. PMID 8411607

Palpation
Duplicate Edit
7.10.3

right lateral decubitus and supine

With the patient in the right lateral decubitus position, the examiner's left hand is slipped from front to back around the left lower thorax, gently lifting the left lowermost rib cage anteriorly and medially. The tips of the fingers of the examiner's right hand are pressed gently just beneath the left costal margin, and the patient is asked to take a long, deep breath as the palpation of a descending spleen is sought. If none is felt, the procedureis repeated, lowering the right hand 2 cm toward the umbilicus each cycle, until the examiner is confident that a massive spleen has not been missed. (Some authorities suggest starting palpation over the lower abdomen and moving up toward the costal margin.) The same procedure can be carried out with the patient supine.

Study: JAMA. 1993 Nov 10;270(18):2218-21. PMID 8411607

Percussion
Duplicate Edit
9.80.4

Nixon's Method: The patient is placed in the right lateraldecubitus position. Percussion is initiated midway along the left costal margin and continued upward along a line perpendicular to the costal margin (Fig 3). In a normal examination, dullness extends no further than 8 cm above the costal margin. Splenomegaly is diagnosed when the upper limit of dullness extends more than 8 cm above the costal margin.

Study: JAMA. 1993 Nov 10;270(18):2218-21. PMID 8411607

Middleton's Maneuver Edit 80.5

The patient is asked to lie flat with his or her left fist under the left costovertebral angle. The examiner is positioned to the patient's left, facing the patient's feet. The fingers of both the examiner's hands are curled under the left costal margin, and the patient is asked to take a long, deep breath as the palpation of a descending spleen is sought.

Study: JAMA. 1993 Nov 10;270(18):2218-21. PMID 8411607

Palpation
Duplicate Edit
7.30.5

all techinques

Study: JAMA. 1993 Nov 10;270(18):2218-21. PMID 8411607

Percussion
Duplicate Edit
2.20.5

Percussion of Traube's space: The patient is supine with the left arm slightly abducted for access to the entire Traube's space (after its description by Ludwig Traube who ascribed its disappearance to pleural effusion, not an enlarged spleen), defined by the sixth rib superiorly, the midaxillary line laterally, and the left costal margin inferiorly (see figure in paper). With the patient breathing normally, this triangle is percussed across one or more levels from its medial to lateral margins. Normal percussion yields a resonant or tympanitic note. Splenomegaly is diagnosed when the percussion note is dull.

Study: JAMA. 1993 Nov 10;270(18):2218-21. PMID 8411607

Good Positive Likelihood Ratio

Finding +LR-LR Comments, Study
Physical Exam Edit inf0.8

i.e. routine physical exam

Study: JAMA. 1993 Nov 10;270(18):2218-21. PMID 8411607

Poorly Diagnostic Findings

Finding +LR-LR Comments, Study
Palpation
Duplicate Edit
1.80.6

supine, two-handed

Study: JAMA. 1993 Nov 10;270(18):2218-21. PMID 8411607