In sonography the upper limit of the size of the spleen is 12 cms. In the last few years on dozens of occasions, I have sent patients for sonography with a "just palpable" spleen, especially in case of typhoid or acute malaria. Invariably the report shows the size as 16-18 or 20 cms. While for more than 50 years, we have been teaching that by the time the spleen becomes just palpable, it has already enlarged to 21/2 - 3 times the normal size.

In fact, I have also sent dozens of patients, whose spleen was enlarged upto midway between the costal margin and the umbilicus (more or less palpable like a kidney lump) for sonography. Surprisingly, no sonologist has ever reported the size of such spleens more than 20-24 cms.
If the above is true, then I am waiting to send a case of massive splenomegaly where the spleen extends upto the umbilicus as in a case of chronic myeloid leukaemia, KalaAzar or tropical malarial splenomegaly. Unfortunately, these conditions are very rare and I have not been able to send a single case of such splenic enlargement to a sonologist.

In olden days, palpation done by a good clinician was considered to be the last word on clinical grounds.The investigation of sonography has come to correct the findings of so-called expert clinicians, who in the past confidently diagnosed an enlarged gall bladder or palpable spleen or kidney lump.

In my opinion, the sonologists should be writing papers, collecting statistics and correcting the concept of spleen palpation by expert clinicians.