Observer Variation in the Clinical and Radiological Assessment of Hepatosplenomegaly

Blendis, Laurence M.; McNeilly, W. J.; Sheppard, Louise; Williams, Roger; Laws, J. W.

doi:10.1136/bmj.1.5698.727

Cited by 47 publications

(21 citation statements)

References 9 publications

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“…Liver involvement is not a rare condition during the advanced stages of Hodgkin's or non-Hodgkin's lymphoma and can be detected at autopsy in 50-80% [2,3,6]. Pathologically, the most common type of intrahepatic involvement of lymphomatous disease is a diffuse distribution of lymphoma throughout the liver parenchyma.…”

Section: Discussionmentioning

confidence: 94%

Hodgkin's and non-Hodgkin's hepatic lymphoma: Sonographic findings

et al. 1993

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The sonographic studies of 72 patients with pathologically proven Hodgkin's or non-Hodgkin's hepatic lymphoma were retrospectively reviewed. Sixty-eight patients (94%) had secondary hepatic lymphoma (nine of them had AIDS-related lymphoma) and four patients (6%) had primary lymphoma of the liver. Forty-six of 72 patients (64%) had diffuse hepatic involvement, and 26 of 72 patients (36%) had focal liver lesions as demonstrated by sonography. Four patterns of disease were identified: (a) hepatomegaly was depicted by sonography in 26 of the 59 patients with secondary hepatic lymphoma not related to AIDS, in two of the nine patients with AIDS-related secondary hepatic lymphoma, and in one of the four patients with primary hepatic lymphoma; (b) multiple rounded well-delineated hypoechoic liver lesions were found in 22 of the 68 patients with secondary hepatic lymphoma; (c) a large heterogeneous echoic mass, which was an evocating clue to the diagnosis of primary lymphoma of the liver, was found in the four patients with primary lymphoma of the liver; and (d) an absence of sonographic abnormalities was found in 20 of the 59 patients with secondary lymphoma not related to AIDS. Liver involvement with lymphoma should be considered in any patient who develops multiple homogeneous hypoechoic liver masses, even in the absence of known underlying lymphomatous disease.

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Section: Discussionmentioning

confidence: 94%

Hodgkin's and non-Hodgkin's hepatic lymphoma: Sonographic findings

et al. 1993

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“…Although there are numerous studies investigating the usefulness and reliability of examining the liver, many suffer from significant design flaws such as selection bias or small sample size, and poor interobserver agreement scores are common. [3][4][5][6][7] However, the finding of a palpable liver edge more than doubled the likelihood that hepatomegaly was present, and the absence of a palpable liver made hepatomegaly less than one half as likely, suggesting that this simple maneuver may be helpful during abdominal examination. Given that the range of probabilities for the presence of hepatomegaly at baseline would be expected to be low, posttest probabilities for hepatomegaly can be calculated.…”

Section: Discussionmentioning

confidence: 99%

Physical Examination of the Liver

Seupaul

Collins

2005

Annals of Emergency Medicine

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“…The included studies involved 1896 participants with ages ranging from 17 to 87 years. [17][18][19][20][21][22][23][26][27][28][29][30][31] One study 22 included the age group of 0-17 years; however, it did not report data on this population. The time frame in which the studies were conducted included two studies in the 1960s, 28,29 three in the 1970s, 26,27,30 and the remaining studies between the years of 1989 and 2000.…”

Section: Study Characteristicsmentioning

confidence: 99%

“…[17][18][19][20][21][22][23][26][27][28][29][30][31] One study 22 included the age group of 0-17 years; however, it did not report data on this population. The time frame in which the studies were conducted included two studies in the 1960s, 28,29 three in the 1970s, 26,27,30 and the remaining studies between the years of 1989 and 2000. [17][18][19][20][21][22][23]31 Ten of the 13 studies [17][18][19][20][21]23,[26][27][28]30 were completed in the inpatient setting; one 22 looked at the population of two different towns in Brazil, and two 29,31 did not state the study setting.…”

Section: Study Characteristicsmentioning

confidence: 99%

“…The time frame in which the studies were conducted included two studies in the 1960s, 28,29 three in the 1970s, 26,27,30 and the remaining studies between the years of 1989 and 2000. [17][18][19][20][21][22][23]31 Ten of the 13 studies [17][18][19][20][21]23,[26][27][28]30 were completed in the inpatient setting; one 22 looked at the population of two different towns in Brazil, and two 29,31 did not state the study setting. All study participants were evaluated for splenomegaly using at least one clinical test and a reference standard for clinical test confirmation.…”

Section: Study Characteristicsmentioning

confidence: 99%

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Diagnostic accuracy of clinical tests for the detection of splenomegaly

Stewart

Derck

Long

et al. 2013

Physical Therapy Reviews

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Background: Due to common pain referral patterns, splenomegaly may present similarly to other conditions commonly seen in the physical therapy setting, and may become deadly if undetected. Therefore, when considering a differential diagnosis for left upper quadrant pain and the appropriateness of physical therapy intervention, it is imperative to screen for splenomegaly. Objective: To summarize the research on the diagnostic accuracy of clinical examination tests for the detection of splenomegaly to determine if physical therapists and other health care providers can rely upon these tests to screen for splenomegaly. Methods: A computer-based search strategy was conducted, using PubMed (MESH terms), Cochrane Central Register of Controlled Trials, ProQuest Nursing & Allied Health Source, SPORTDiscus, CINAHL, and SCOPUS databases (key words). Selection required: (1) an assessment of individual clinical measures of splenomegaly, (2) diagnostic accuracy measures for clinical tests, (3) an acceptable reference standard for comparison, and (4) a case-control or case-based case-control design. Electronic and hand search limits included English-written and human studies. Results: The studies included Nixon's percussion, Castell's percussion, percussion of Traube's space, bimanual palpation of the spleen, ballottement of the spleen, Middleton's maneuver, and the combination of percussion and palpation testing. For each clinical test from each study, diagnostic accuracy measures were reported as well as reliability, when available. Quality scores were tabulated for each study using the QUADAS instrument and studies were dichotomized into high ( §10/14) or low (,10/14) quality based on QUADAS scores. Thirteen articles qualified for inclusion, of which four were identified as high quality. When comparing high quality studies, palpation techniques yielded specificity values of 82-93 and sensitivity values of 31-85.6, whereas percussion techniques presented with lower values in both specificity (32.6-87) and sensitivity (22-85.7). Conclusion: There is moderate evidence for the use of palpation tests for ruling in splenomegaly and limited evidence to support the use of palpation or percussion techniques for ruling out this condition. More high quality studies are needed.

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Observer Variation in the Clinical and Radiological Assessment of Hepatosplenomegaly

Cited by 47 publications

References 9 publications

Hodgkin's and non-Hodgkin's hepatic lymphoma: Sonographic findings

Hodgkin's and non-Hodgkin's hepatic lymphoma: Sonographic findings

Physical Examination of the Liver

Diagnostic accuracy of clinical tests for the detection of splenomegaly

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