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November 10, 1993, Vol 270, No. 18 >
ARTICLE | November 10, 1993

Does This Patient Have Splenomegaly? FREE

Steven A. Grover, MD, MPA, FRCPC; Alan N. Barkun, MD, FRCPC; David L. Sackett, FRSC, MD, FRCPC
[+] Author Affiliations

Reprint requests to Montreal General Hospital, 1650 ave Cedar, Montreal, Quebec, Canada H3G 1A4 (Dr Grover).


JAMA. 1993;270(18):2218-2221. doi:10.1001/jama.1993.03510180088040
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References

THREE PATIENTS  Among the patients you are seeing today are the following three:The first is an elderly woman who complains of easy fatigability, and her conjunctivae and nail beds are pale. You suspect that she is anemic due to gastrointestinal blood loss, but among your differential diagnoses you consider a lymphoproliferative disorder and decide to examine her for splenomegaly.The second is a college student with failing appetite, ability to concentrate, energy, and grades. You think that he is depressed but want to rule out infectious mononucleosis and decide to examine him for splenomegaly.The third is an otherwise healthy, well-controlled, hypertensive male with a normal cardiovascular examination. As he lies on the examining table, stripped to his waist, you wonder whether you should take the time to examine him for splenomegaly.

WHY EXAMINE THE SPLEEN?  We examine the spleen to see whether it is palpable. Most palpable spleens

REFERENCES

1 +
Ebaugh FG, McIntyre OR.  Palpable spleens: ten-year follow-up. Ann Intern Med . 1979;;90:130-131.
2 +
Myers J, Segal RJ.  Weight of the spleen, I: range of normal in a nonhospital population. Arch Pathol . 1974;;98:33-35.
3 +
Larson SM, Tuell SH, Moores KD, Nelp WB.  Dimensions of the normal adult spleen scan and prediction of spleen weight. J Nucl Med . 1971;;12: 123-126.
4 +
Westin J, Lanner SO, Larsson A, Weinfeld A.  Spleen size in polycythemia: a clinical and scintigraphic study. Acta Med Scand . 1972;;191:263-271.
5 +
Zhang B, Lewis SM.  Use of radionuclide scanning to estimate size of spleen in vivo. J Clin Pathol . 1987;;40:508-511.
6 +
Niederau C, Sonnenberg A, Mueller JE, Erckenbrecht JF, Scholten T, Fritsch WP.  Sonographic measurements of the normal liver, spleen, pancreas, and portal vein. Radiology . 1983;;149:537-540.
7 +
Koga T, Morikawa Y.  Ultrasonographic determination of the splenic size and its clinical usefulness in various liver diseases. Radiology . 1975;;115: 157-161.
8 +
Nixon RK Jr.  The detection of splenomegaly by percussion. N Engl J Med . 1954;;250:166-167.
9 +
Sullivan S, Williams R.  Reliability of clinical techniques for detecting splenic enlargement. BMJ . 1976;; 2:1043-1044.
10 +
Castell DO.  The spleen percussion sign: a useful diagnostic technique. Ann Intern Med . 1967;;67:1265-1267.
11 +
Talbott JE. A Biographical History of Medicine: Excerpts and Essays on the Men and Their Work . New York, NY: Grune and Stratton; 1970;: 594-595.
12 +
Barkun AN, Camus M, Meagher T, et al.  Splenic enlargement and Traube's space: how useful is percussion? Am J Med . 1989;;87:562-566.
13 +
Shaw MT, Dvorak V.  Palpation of slightly enlarged spleens. Lancet . 1973;;1:317.
14 +
Barkun AN, Camus M, Green L, et al.  The bedside assessment of splenic enlargement. Am J Med . 1991;;91:512-518.
15 +
Espinoza P, Ducot B, Pelletier G, et al.  Interobserver agreement in the physical diagnosis of alcoholic liver disease. Dig Dis Sci . 1987;;32:244-247.
16 +
Blendis LM, McNeilly WJ, Sheppard L, Williams R, Laws JW.  Observer variation in the clinical and radiological assessment of hepatosplenomegaly. BMJ . 1970;;1:727-730.
17 +
Riemenschneider PA, Whalen JP.  The relative accuracy of estimation of enlargement of the liver and spleen by radiologic and clinical methods. AJR Am J Roentgenol . 1965;;94:462-468.
18 +
Halpern S, Coel M, Ashburn W, et al.  Correlation of liver and spleen size: determinations by nuclear medicine studies and physical examination. Arch Intern Med . 1974;;134:123-124.
19 +
Ingeberg S, Stockel M, Sorensen PJ.  Prediction of spleen size by routine radioisotope scintigraphy. Acta Haematol . 1983;;69:243-248.
20 +
McIntyre RR, Ebaugh FGJr.  Palpable spleens in college freshmen. Ann Intern Med . 1967;;66:301-306.
21 +
Berris B.  The incidence of palpable liver and spleen in the postpartum period. Can Med Assoc J . 1966;;95:1318-1319.

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1 +
Ebaugh FG, McIntyre OR.  Palpable spleens: ten-year follow-up. Ann Intern Med . 1979;;90:130-131.
2 +
Myers J, Segal RJ.  Weight of the spleen, I: range of normal in a nonhospital population. Arch Pathol . 1974;;98:33-35.
3 +
Larson SM, Tuell SH, Moores KD, Nelp WB.  Dimensions of the normal adult spleen scan and prediction of spleen weight. J Nucl Med . 1971;;12: 123-126.
4 +
Westin J, Lanner SO, Larsson A, Weinfeld A.  Spleen size in polycythemia: a clinical and scintigraphic study. Acta Med Scand . 1972;;191:263-271.
5 +
Zhang B, Lewis SM.  Use of radionuclide scanning to estimate size of spleen in vivo. J Clin Pathol . 1987;;40:508-511.
6 +
Niederau C, Sonnenberg A, Mueller JE, Erckenbrecht JF, Scholten T, Fritsch WP.  Sonographic measurements of the normal liver, spleen, pancreas, and portal vein. Radiology . 1983;;149:537-540.
7 +
Koga T, Morikawa Y.  Ultrasonographic determination of the splenic size and its clinical usefulness in various liver diseases. Radiology . 1975;;115: 157-161.
8 +
Nixon RK Jr.  The detection of splenomegaly by percussion. N Engl J Med . 1954;;250:166-167.
9 +
Sullivan S, Williams R.  Reliability of clinical techniques for detecting splenic enlargement. BMJ . 1976;; 2:1043-1044.
10 +
Castell DO.  The spleen percussion sign: a useful diagnostic technique. Ann Intern Med . 1967;;67:1265-1267.
11 +
Talbott JE. A Biographical History of Medicine: Excerpts and Essays on the Men and Their Work . New York, NY: Grune and Stratton; 1970;: 594-595.
12 +
Barkun AN, Camus M, Meagher T, et al.  Splenic enlargement and Traube's space: how useful is percussion? Am J Med . 1989;;87:562-566.
13 +
Shaw MT, Dvorak V.  Palpation of slightly enlarged spleens. Lancet . 1973;;1:317.
14 +
Barkun AN, Camus M, Green L, et al.  The bedside assessment of splenic enlargement. Am J Med . 1991;;91:512-518.
15 +
Espinoza P, Ducot B, Pelletier G, et al.  Interobserver agreement in the physical diagnosis of alcoholic liver disease. Dig Dis Sci . 1987;;32:244-247.
16 +
Blendis LM, McNeilly WJ, Sheppard L, Williams R, Laws JW.  Observer variation in the clinical and radiological assessment of hepatosplenomegaly. BMJ . 1970;;1:727-730.
17 +
Riemenschneider PA, Whalen JP.  The relative accuracy of estimation of enlargement of the liver and spleen by radiologic and clinical methods. AJR Am J Roentgenol . 1965;;94:462-468.
18 +
Halpern S, Coel M, Ashburn W, et al.  Correlation of liver and spleen size: determinations by nuclear medicine studies and physical examination. Arch Intern Med . 1974;;134:123-124.
19 +
Ingeberg S, Stockel M, Sorensen PJ.  Prediction of spleen size by routine radioisotope scintigraphy. Acta Haematol . 1983;;69:243-248.
20 +
McIntyre RR, Ebaugh FGJr.  Palpable spleens in college freshmen. Ann Intern Med . 1967;;66:301-306.
21 +
Berris B.  The incidence of palpable liver and spleen in the postpartum period. Can Med Assoc J . 1966;;95:1318-1319.

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