[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Clinical exam](https://durgical.com/en/clinical-exam/) › [Abdomen](https://durgical.com/en/clinical-exam/#a-abdomen) › Abdominal percussion: liver span and tympany [Clinical exam](https://durgical.com/en/clinical-exam/) · [Abdomen](https://durgical.com/en/clinical-exam/#a-abdomen) # 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](https://durgical.com/en/anatomy/liver/) · [Spleen](https://durgical.com/en/anatomy/spleen/) · [Stomach](https://durgical.com/en/anatomy/stomach/) · [Urinary bladder](https://durgical.com/en/anatomy/urinary-bladder/) · [Diaphragm](https://durgical.com/en/anatomy/diaphragm/) ## Key points - Normal note: tympanic over most of the abdomen; dull over the liver and over a full bladder. - Liver span at the right midclavicular line: in adults usually about 6 to 12 cm, measured between the upper and lower edges of dullness. - Generalized tympany with distension: gas (obstruction, ileus); dull flanks with distension: fluid (ascites). - Suprapubic dullness with a convex upper border: distended bladder (urinary retention). - Dullness in the lowest left intercostal space at the anterior axillary line on inspiration (Castell sign): suggests splenomegaly. - Localized percussion tenderness signals peritoneal irritation and hurts less than testing for rebound. ## 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. [Add to my cards (3)](https://durgical.app/estudiar/?add=/en/clinical-exam/abdominal-percussion-liver-span-and-tympany/) ## See it in 3D The structures of Durgical's 3D anatomy where it is found. - [Liver](https://durgical.com/en/anatomy/liver/) - [Spleen](https://durgical.com/en/anatomy/spleen/) - [Stomach](https://durgical.com/en/anatomy/stomach/) - [Urinary bladder](https://durgical.com/en/anatomy/urinary-bladder/) - [Diaphragm](https://durgical.com/en/anatomy/diaphragm/) ## Related - [Abdominal auscultation: bowel sounds and bruits](https://durgical.com/en/clinical-exam/abdominal-auscultation-bowel-sounds-and-bruits/) - [Abdominal palpation: light and deep, guarding and masses](https://durgical.com/en/clinical-exam/abdominal-palpation-light-and-deep-guarding-and-masses/) - [Ascites: shifting dullness and fluid wave](https://durgical.com/en/clinical-exam/ascites-shifting-dullness-and-fluid-wave/) - [Palpation of the liver and spleen](https://durgical.com/en/clinical-exam/palpation-of-the-liver-and-spleen/) - [Costovertebral angle tenderness (fist percussion)](https://durgical.com/en/clinical-exam/costovertebral-angle-tenderness/) - [Chest percussion: resonance, dullness and hyperresonance](https://durgical.com/en/clinical-exam/chest-percussion-resonance-dullness-and-hyperresonance/) - [Bladder examination: the distended bladder](https://durgical.com/en/clinical-exam/bladder-examination-the-distended-bladder/) ## Related conditions - [Cirrhosis](https://durgical.com/en/conditions/cirrhosis/) - [Small bowel obstruction](https://durgical.com/en/conditions/small-bowel-obstruction/) - [Large bowel obstruction](https://durgical.com/en/conditions/large-bowel-obstruction/) [← All of the clinical exam](https://durgical.com/en/clinical-exam/) 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](https://www.merckmanuals.com/professional/gastrointestinal-disorders/approach-to-the-gastrointestinal-patient/evaluation-of-the-gastrointestinal-patient) (Merck & Co., Inc., 2025); [Abdominal examination](https://en.wikipedia.org/wiki/Abdominal_examination) (Wikipedia, 2026); [Evaluation of the Patient With a Liver Disorder - Merck Manual Professional Edition](https://www.merckmanuals.com/professional/hepatic-and-biliary-disorders/approach-to-the-patient-with-liver-disease/evaluation-of-the-patient-with-a-liver-disorder) (Merck & Co., Inc., 2025). ## **Spotted a mistake?** We are always improving for the community. Tell us what is wrong and our team will review it. Report a mistake Representative model, for educational purposes only. --- Source: https://durgical.com/en/clinical-exam/abdominal-percussion-liver-span-and-tympany/ License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/clinical-exam/abdominal-percussion-liver-span-and-tympany/