During abdominal examination, the edge of the spleen is palpable at the left costal margin. Which maneuver confirms splenic enlargement?

• A. Roll the patient onto the right side and palpate for the spleen edge.
• B. Roll the patient onto the left side and palpate for the spleen edge.
• C. Have the patient get into the knee-chest position.
• D. Have the patient sit upright and palpate in the left costal vertebral angle.

Answer: (A)

Repositioning the patient to reveal where the spleen lies is the key idea. When the spleen is enlarged, it shifts downward and anteriorly due to gravity. Rolling the patient onto the right side brings the spleen forward and closer to the abdominal wall, so the examiner can palpate its edge below the left costal margin during inspiration. This maneuver makes splenomegaly more conspicuous than in the neutral position.

Rolling to the left side wouldn’t aid because it tends to keep the spleen tucked posteriorly and less accessible. The knee-chest position doesn’t reposition the spleen toward the surface, and palpating in the left costal vertebral angle focuses on the kidney region rather than assessing splenic enlargement.