Abdominal percussion: liver span and tympany !
- Exam technique
Tapping on the abdomen with the fingers to tell whether air (hollow sound) or an organ or fluid (dull sound) lies beneath.
Updated 2026-11-01
See it in 3D: Liver · Spleen · Stomach · Urinary bladder · Diaphragm
What it is
Percussion is the third stage of the abdominal exam, after auscultation and before deep palpation. The normal note is mostly tympanic because of bowel gas; dullness appears over solid organs, masses, fluid or a full bladder. It lets you measure the liver span, suspect splenomegaly, tell gas from fluid distension and find a distended bladder. Percussion tenderness is also a gentle sign of peritoneal irritation.
Landmark anatomy
- The upper edge of liver dullness usually lies in the fifth to seventh intercostal space at the midclavicular line; the lower edge at or just below the costal margin.
- Traube space is a crescent of tympany over the gastric air bubble, bounded by the sixth rib, the anterior axillary line and the left costal margin.
- The normal spleen lies under the left ninth to eleventh ribs at the midaxillary line and gives no anterior dullness.
Technique, step by step
- Patient supine and relaxed; examiner on the right with warm hands.
- Finger-on-finger: press one middle finger firmly on the wall and strike its middle phalanx with the tip of the other middle finger, using a wrist flick.
- Percuss all four quadrants in order and note where the note is tympanic and where it is dull.
- Liver span: at the right midclavicular line, percuss down from a resonant area of the chest to the first dullness (upper edge).
- Then percuss up from the right lower quadrant, in tympany, to the dullness (lower edge) and measure the distance.
- Spleen: percuss Traube space and the lowest left intercostal space at the anterior axillary line, in expiration and in deep inspiration.
- If the abdomen is distended, percuss the flanks and, if dull, test for shifting dullness.
- Percuss the hypogastrium from the umbilicus down to the pubis to look for a distended bladder.
Abnormal findings
- Increased liver span: hepatomegaly (heart failure, hepatitis, fatty liver, infiltration, metastases).
- Reduced span or loss of liver dullness: advanced cirrhosis or free air in the peritoneum (pneumoperitoneum from perforation).
- Liver pushed down without being enlarged: lung hyperinflation (COPD) pushing the diaphragm down.
- Dull Traube space: splenomegaly, left pleural effusion or a full stomach.
- Flank dullness that shifts with position: ascites.
Common errors
- Striking too hard underestimates liver size; light taps define the edges better.
- Mistaking the dullness of a right pleural effusion for the upper edge of the liver.
- Percussing Traube space after a meal: a full stomach gives dullness without splenomegaly.
Test yourself
Think of the answer, then tap the question to see it.
How do you measure the liver span by percussion?
At the right midclavicular line, percuss down from the resonant chest to dullness and up from abdominal tympany to dullness; measure the distance between the two edges.
What does loss of liver dullness suggest in a patient with sudden abdominal pain?
Free air in the peritoneal cavity from perforation of a hollow organ.
What does suprapubic dullness with an upward-convex border suggest?
A bladder distended by urinary retention.
See it in 3D
The structures of Durgical's 3D anatomy where it is found.
Related
- Abdominal auscultation: bowel sounds and bruits
- Abdominal palpation: light and deep, guarding and masses
- Ascites: shifting dullness and fluid wave
- Palpation of the liver and spleen
- Costovertebral angle tenderness (fist percussion)
- Chest percussion: resonance, dullness and hyperresonance
- Bladder examination: the distended bladder
Related conditions
Educational content on the clinical exam; it is learned and practised under supervision. It does not replace assessment by a health professional and is not for self-diagnosis.
Sources: Evaluation of the Gastrointestinal Patient - Gastroenterology - Merck Manual Professional Edition (Merck & Co., Inc., 2025); Abdominal examination (Wikipedia, 2026); Evaluation of the Patient With a Liver Disorder - Merck Manual Professional Edition (Merck & Co., Inc., 2025).
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Representative model, for educational purposes only.