On clinical examination  of patient  with abdominal  pain, you find a mass in the left hypochondrium.  List 4 clinical features will you use to distinguish between a palpable spleen and the left kidney?

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College Answer

Presence of a notch – spleen
Spleen moves inferomedially on inspiration
Not ballotable or bimanually palpable
Usually no band of resonance over s splenic mass
Spleen has no palpable upper border
Dullness over ribs 9,10, 11

Discussion

This is another question which reaches into a deep dark recess of Talley and O'Connor.

The differences between spleens and kidneys are mobility, ballotability, and edge palpation.

  • Thus, the spleen is mobile with respiration, whereas the kidneys is not.
  • The kidney is "ballotable" whereas the spleen is not.
  • The spleen has a notch on the anterior surface, and the kidney does not
  • The spleen should be dull to percussion, where the kidney can be resonant due to overlying gas
  • The spleen enlarges diagonally, towards the umbilicus and the RLQ, whereas the kidney enlarges inferiorly, to the ipsilateral pelvis.
  • There is no palpable upper border to the spleen, whereas the kidney should have one

The reference for the above wisdom, shamefully, is Wikiversity.