Expansion
Enlarges downwards and medially, towards the right iliac fossa
Expansion
The spleen enlarges downwards and medially, along the line of the tenth rib towards the right iliac fossa, because the diaphragm and ribs prevent it expanding upwards or laterally.
Distinguishing an enlarged spleen from an enlarged left kidney:
| Feature | Spleen | Kidney |
|---|---|---|
| Can you get above it? | No | Yes |
| Notch on the medial border | Yes | No |
| Moves with respiration | Markedly, downwards and medially | Slightly, downwards |
| Ballottable bimanually | No | Yes |
| Percussion note over it | Dull | Resonant (overlying colon) |
| Direction of enlargement | Towards right iliac fossa | Downwards |
The splenic notch on the superior border is the single most specific sign.