Expansion
Upper border at the fifth intercostal space, lower border at the right costal margin
Expansion
- Upper border - about the fifth intercostal space in the right mid-clavicular line, beneath the diaphragm
- Lower border - at or just below the right costal margin
- Normal span - about 12 to 15 cm in the mid-clavicular line
The liver moves downwards on inspiration, which is why palpation starts in the right iliac fossa and moves up in step with the patient’s breathing.
The single most important pitfall is failing to percuss the upper border. In chronic obstructive pulmonary disease the flattened diaphragm displaces the whole liver downwards, making it easily palpable while the span remains normal, displacement, not hepatomegaly.
Riedel’s lobe is a normal variant: a tongue-like inferior extension of the right lobe that can be mistaken for hepatomegaly or a gallbladder mass.