The anatomical position of the spleen is behind and below the left 9th. 10th and 11th rib and its
long axis is lies along the direction of the left 10th rib
Its antero inferior end extends maximally upto the midaxiilary line
Postero-superior end lies 1-2 inches lateral to the T10 spine
The upper border of normal splenic dullness is present in left 9th rib and lor this reason the 8th ICS (space above the 9th rib) in left midaxillarv line is always resonant on percussion.
Nixon's method of percussion of spleen
- The patient is asked to lie on the right side so that the spleen lies above the colon and stomach.
- Percussion begins at the lower level of pulmonary resonance in the posterior axillary line and proceeds diagonally along a perpendicular line toward the lower mid anterior costal margin.
- The upper border of dullness is normally 6-8 cm above the costal margin. Dullness greater than 8cm in an adult is considered as an indicator of splenic enlargement
- Ask the patient to be in supine posture
- Percuss the left axilla from above downwards along the midaxiilary line (keeping the patient s left hand on his head to expose the axilla).
- Percussion in the lowest intercostal space in the anterior axillary (8th or 9th) produces a resonant note if the spleen is normal in size. This is true during expiration or full inspiration.
- If the 8th ICS or spaces above are dull on percussion even on full inspiration it is expected that spleen has enlarged.
