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August 17, 1994

Splenomegaly and Percussion: Is the Background Noise Due to Tongue in Cheek?-Reply

Author Affiliations

McGill University Montreal, Quebec
McMaster University Hamilton, Ontario

JAMA. 1994;272(7):516. doi:10.1001/jama.1994.03520070034023

In Reply.  —Dr Rosenman may be quite correct that an expert in the magical art of percussion requires a soft touch, a sharp ear, and a tongue in cheek. However, we believe that our review of the bedside assessment of splenomegaly dealt not with the art of percussion, but with the science for which a tongue in cheek can only introduce background noise that obscures the truth.In reviewing clinical studies objectively evaluating the precision and accuracy of percussion and palpation, we hoped to provide a rational set of guidelines that identified the clinical situations where these bedside maneuvers might be useful to diagnose splenic enlargement. Just as important, we also identified clinical scenarios in which these maneuvers are probably of little clinical value, such as ruling out splenomegaly.Accordingly, we agree with Rosenman that the art of percussion is best practiced by drum players. However, we believe there remains

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