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
- Have the patient lie in the supine position.
- Start percussing from the umbilicus and move laterally to the left of the abdomen.
- Find the border where the percussion transitions from tympanic to dull. Mark the border.
- Have the patient turn onto their right side and percuss laterally from one side of the marked border to the other.
- 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.
- The test is moderately sensitive (0.83), but non-specific (0.56).
- Bickley LS, Szilagyi PG. Bates’ Guide to Physical Examination and History Taking. 10th ed. Philadelphia, PA: Wolter Kluwer Health; 2009.
- 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.