Shifting dullness

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

The shifting dullness refers to a sign, elicited on physical examination, for ascites. If, on percussion, the region of dullness shifts when the patient is turned from supine position to side-lying, they probably have fluid in the abdomen. If the borders between tympanic and dullness remain the same, the person likely does not have ascites.

(Images courtesy of Charlie Goldberg, M.D., UCSD School of Medicine and VA Medical Center, San Diego, California)

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  Shifting Dullness: Supine position
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  Shifting Dullness: Right lateral position

• Abdominal examination
• Fluid wave test
• Bulging flanks
• Puddle sign

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