[Skip to Content]
[Skip to Content Landing]
October 28, 1992

The Rational Clinical Examination-Reply

Author Affiliations

San Antonio, Tex

JAMA. 1992;268(16):2166. doi:10.1001/jama.1992.03490160034013

This article is only available in the PDF format. Download the PDF to view the article, as well as its associated figures and tables.


In Reply.  —Dr Lamb shares our enthusiasm for physical diagnosis and offers comments about other potentially useful signs for diagnosing ascites. He observes that an everted umbilicus is almost always due to ascites and advocates "Myers maneuver" for detecting a fluid wave, suggesting that it is easier to perform and as accurate as the traditional method for eliciting a fluid wave. For detecting small amounts of fluid, he suggests we use a "percussion variant" of the puddle sign. We suspect that other readers have favorite physical examination techniques that they believe useful for detecting ascites. Indeed, these techniques may improve on our existing repertoire of physical diagnosis maneuvers. However, we found no data on these tests in the literature, and unless Lamb has found something we missed, their accuracy is unknown. To separate the wheat from the chaff, we must rigorously test these findings so that the clinician will know