Castell's sign: Difference between revisions

Latest revision as of 06:28, 16 February 2025

A clinical sign used in the diagnosis of splenomegaly

Castell's sign[edit]

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[edit]

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[edit]

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[edit]

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[edit]

@@ Line 1: / Line 1: @@
-'''Castell's sign''' is a clinical diagnostic technique used in the assessment of [[splenomegaly]] and potentially other abdominal organ enlargements. It was named after Dr. Don Antonio Castell, an American physician who described this method in the mid-20th century. The sign is particularly useful in detecting an enlarged spleen by percussing the lowest intercostal space in the left anterior axillary line.
+{{Short description|A clinical sign used in the diagnosis of splenomegaly}}
-==Procedure==
+== Castell's sign ==
-The examination is performed with the patient lying down (supine). The physician percusses the lowest intercostal space in the left anterior axillary line. Initially, this is done while the patient is taking a deep breath. Normally, this area would resonate with a tympanic sound due to the presence of lung tissue. However, if the spleen is enlarged, it displaces the lung upwards and occupies the space where tympany was expected, resulting in a dull sound upon percussion. This change in percussion note from tympany to dullness on inspiration is considered a positive Castell's sign, suggesting splenomegaly.
+[[File:Gray1217-Castells_Point-b.png|thumb|right|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.
-==Clinical Significance==
+== Technique ==
-Castell's sign is a non-invasive, simple, and cost-effective method for detecting splenomegaly. It is particularly useful in settings where advanced imaging techniques such as [[ultrasound]] or [[computed tomography]] (CT) scans are not readily available. While it is a helpful diagnostic tool, it is important to note that a negative Castell's sign does not rule out splenomegaly. The sensitivity and specificity of this sign can vary, and its diagnostic accuracy is not absolute. Therefore, it should be used in conjunction with other clinical findings and diagnostic tests.
+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]].
-==Differential Diagnosis==
+=== Interpretation ===
-In the context of a positive Castell's sign, differential diagnosis may include various conditions that lead to splenomegaly, such as:
+* '''Normal (Negative Castell's sign):''' The percussion note remains resonant (tympanic) during both expiration and inspiration.
-* [[Infectious mononucleosis]]
+* '''Abnormal (Positive Castell's sign):''' The percussion note changes from resonant to dull during inspiration, indicating possible splenomegaly.
-* [[Leukemia]]
-* [[Lymphoma]]
-* [[Hemolytic anemia]]
-* [[Liver cirrhosis]]
-* [[Portal hypertension]]
-==Limitations==
+== Clinical significance ==
-The main limitation of Castell's sign is its variability in sensitivity and specificity. Factors such as the patient's body habitus, the presence of gas in the colon, or a massively enlarged spleen that extends beyond the left anterior axillary line can affect the outcome of the test. Additionally, other conditions that may cause displacement or enlargement of organs in the left upper quadrant can potentially lead to false-positive results.
+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.
-==Conclusion==
+== Related pages ==
-Castell's sign remains a valuable clinical tool for the initial assessment of splenomegaly, especially in resource-limited settings. However, its limitations necessitate the use of additional diagnostic methods for confirmation. As with any clinical sign, Castell's sign should be interpreted within the context of the entire clinical picture.
+* [[Splenomegaly]]
+* [[Physical examination]]
+* [[Percussion (medicine)]]
+* [[Spleen]]
 [[Category:Medical signs]]
-[[Category:Hematology]]
+[[Category:Physical examination]]
-[[Category:Gastroenterology]]
-{{Medicine-stub}}