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Estimate ultrasonographic liver size by multiplying physical exam size by 1.6
Clinical Question
How do physical examination estimates compare with ultrasound measurements of liver size?
Bottom line
Physical examination estimates of liver size are like vertical measurements of a television, whereas ultrasound determinations are more like diagonal measurements. This study developed a fudge factor: multiplying the percussed liver size by 1.6 will put you within 10% of the actual liver size 76% of the time. 2b
Reference
Study design: Cohort (prospective)
Funding: Self-funded or unfunded
Setting: Outpatient (specialty)
Synopsis
These investigators enrolled 101 adults with known liver disease (53% were women; average age 49.5 years) who were undergoing liver biopsy and who had liver size estimated by physical examination and by ultrasound. Physical examination estimates were obtained by using percussion at the midclavicular line.The exams were conducted by a single hepatologist so the exam findings may have been a little more accurate than those obtained by clinicians who don't spend most of their days thumping livers. Liver size on ultrasound was obtained using an oblique/transaxially approach. By physical exam, the average liver size was 8.9 cm; by ultrasound, it was 14.3 cm. By comparing all the measurements with one another, the investigators found a nice linear correlation between measurements (correlation coefficient = .7). Multiplying the physical examination measurement by 1.6 resulted in an estimate that was within 10% of ultrasound findings in 76% of cases.
Reviewer
Allen F. Shaughnessy, PharmD, MMedEd
Professor of Family Medicine
Tufts University
Boston, MA
Comments
really great twist on an old clinical skill
Back in the day....pre ultrasound ease of availability we "thumped" everyone's liver. I still do it- reflex. This is great to correlate to actual size. I am going to try it out.