Chronic sarcoid arthritis

Our findings show that the combination of splenic percussion and palpation will detect up to 88% of spleens considered to be enlarged on hepatic scintiscans. In other studies the correlation between clinical detection of splenomegaly and radiography or radioisotope scanning has been poor. Although as little as a 4000 increase in spleen size may be palpable, even massively enlarged spleens have occasionally gone clinically undetected. Perhaps the error is in the standard used for comparison. The borders of the spleen may not be identifiable on a radiograph and hepatic scans in which the peak count rate is set over the liver will often underestimate the actual size of the spleen. Some enlarged spleens may be undetected by both clinical and radiological techniques. Likewise, some spleens that appear enlarged by palpation or percussion, although not by radiography or scanning, may be enlarged. Nevertheless, not every palpable spleen is abnormal or enlarged, and up to 29% of healthy young people4 and up to 5.6% of a general patient population5 may have palpable spleens. In only slightly over half will an adequate explanation for the splenic palpability be found. We can confirm that apparently normal spleens may be palpable but, in contrast to other studies, we have also shown that, with falsepositives often due to hepatomegaly or abdominal masses, careful percussion and palpation will detect most enlarged spleens. Careful delineation of the left lobe of the liver may improve accuracy even further.