Exam

Puddle Sign

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Puddle Sign

  • Indication
  1. Detects Ascites down to 120 cc of free fluid
  • Technique
  1. Patient lies prone for 5 minutes
  2. Patient then rises onto elbows and knees
  3. Apply stethoscope diaphragm to most dependent Abdomen
  4. Examiner repeatedly flicks near flank with finger
    1. Continue to flick at same spot on Abdomen
  5. Move stethoscope across Abdomen away from examiner
  6. Sound loudness increases at farther edge of puddle
  7. Sound transmission does not change when patient sits
  • Interpretation
  1. Augmentation of sound intensity suggests Ascites