Castell's sign

A clinical sign used in the diagnosis of splenomegaly

Castell's sign

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Diagram showing Castell's point, where percussion is performed.

Castell's sign is a clinical sign used in the physical examination of the abdomen to detect splenomegaly, which is an enlargement of the spleen. It is named after the American physician Donald Castell, who described the technique.

Technique

To elicit Castell's sign, the patient is positioned in the supine position (lying on their back). The examiner percusses (taps) the lowest intercostal space (usually the 8th or 9th) in the left anterior axillary line, which is known as Castell's point. The percussion is performed first during expiration and then during inspiration.

Interpretation

• Normal (Negative Castell's sign): The percussion note remains resonant (tympanic) during both expiration and inspiration.
• Abnormal (Positive Castell's sign): The percussion note changes from resonant to dull during inspiration, indicating possible splenomegaly.

Clinical significance

Castell's sign is a useful bedside test for detecting splenomegaly, which can be associated with various conditions such as infectious mononucleosis, cirrhosis, hematological disorders, and portal hypertension. It is important to note that Castell's sign is not definitive for splenomegaly and should be used in conjunction with other clinical findings and diagnostic tests.

Related pages

• Splenomegaly
• Physical examination
• Percussion (medicine)
• Spleen