Castell's Sign - History

History

Donald O. Castell first described his sign in the 1967 paper, “The Spleen Percussion Sign” published in Annals of Internal Medicine. Castell, a George Washington Medical School graduate, is also a Navy-trained gastroenterologist. While stationed at the Great Lakes naval base in northern Illinois, Castell studied 20 male patients, 10 of whom had a positive percussion sign and 10 patient controls with negative percussion signs. The spleen of each patient was then quantitatively measured using chromium-labeled erythrocytes and radioisotope photoscan of the spleen. Castell showed those patients in the control group had a mean spleen size of 75 cm2 with a range of 57 cm2 to 75 cm2, while those who had a positive percussion sign had a mean spleen size of 93 cm2 with a range of 77 cm2 to 120 cm2. Castell concluded that his technique of spleen percussion was thus useful in identifying “slight to moderate degrees of splenic enlargement” and, as a result, constituted a “valuable diagnostic technique.”