shifting dullness in ascites
Shifting dullness is a sign of ascites. It should be sought whenever ascites is suspected or dullness is detected in the flanks during routine percussion of the abdomen.
Percuss out to the left flank. Observe and mark the point at which the percussion note changes from resonant to dull.
Roll the patient 45 degrees to the right. Allow time for the fluid to move inside the abdominal cavity. One minute is usually sufficient. Repeat the percussion over the marked area. The area of dullness should now be resonant as the peritoneal fluid will have moved under the influence of gravity to the right side of the abdomen, which is now the lowermost point.
Last reviewed 01/2018