OnExam

Shifting dullness is a relatively simple test that is used to aid in the diagnosis of ascites. It is often used in conjunction with the fluid wave test.

Performing the Test

  1. Have the patient lie in the supine position.
  2. Start percussing from the umbilicus and move laterally to the left of the abdomen.
  3. Find the border where the percussion transitions from tympanic to dull. Mark the border.
  4. Have the patient turn onto their right side and percuss laterally from one side of the marked border to the other.
  5. A positive test is when tympany shifts to the furthest lateral point (ie. The point furthest from the ground) when the patient is on their right side.

Interpretation

  • The test is moderately sensitive (0.83), but non-specific (0.56).

References

  1. Bickley LS, Szilagyi PG. Bates’ Guide to Physical Examination and History Taking. 10th ed. Philadelphia, PA: Wolter Kluwer Health; 2009.
  2. Catau EL, Benjamin SB, Knuff TE, Castell DO. The Accuracy of the Physical Examination in the Diagnosis of Suspected Ascites. JAMA. 1982; 247: 1164-1166.