This study was undertaken to determine the accuracy of splenic
palpation for the diagnosis of splenomegaly, and to determine whether
the frequency of individuals with a palpable spleen in an endemic area
can be considered as an index of morbidity of schistosomiasis. For the
clinical diagnosis of splenomegaly, two criteria have been tested: (A)
presence of a palpable spleen and (B) presence of a palpable spleen
whose border could be felt more than 4 cm below the costal margin. In
an area of high prevalence of the disease (66.3%) 285 individuals aged
18 years or more have been submitted to abdominal ultrasonography and
physical examination. Splenomegaly was defined as a splenic length
greater than 120 mm by ultrasound and the sensitivity, specificity,
positive and negative predictive values of criterion A were 72.2%,
90.5%, 35.1% and 97.8%. The values for criterion B were 27.8%, 98%,
50% and 95%, respectively. In an non endemic area, 517 individuals
were submitted to the same protocol and 22 individuals had a palpable
spleen, but no patient fulfilled criterion B for splenomegaly, and
only one met the ultrasonographic criterion for splenomegaly. The
authors concluded that abdominal palpation is a poor method for the
diagnosis of splenomegaly.
