Traube's space

Traube's semilunar space, also referred to as Traube's space, is a matter of hot discussion among medical students. Some teachers say that it is an important part of clinical examination, while others brush it aside. As a result, there is an element of confusion in the student's mind.

History:
Named after Ludwig Traube. A physician and professor at University of Berlin, died 1876.
His student reported this clinical sign in 1868:

O. Fraentzel: Bemerkungen über den halbmondförmigen Raum und über den Vocalfremitus.
Berliner klinische Wochenschrift, 1868, 5: 509-511.
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In German. Published in the Berlin Clinical Weekly Review

What is it?
Traube's space is an anatomic region of some clinical importance.

Anatomical boundaries:
It's a crescent-shaped space, encompassed by the lower edge of the left lung, the anterior border of the spleen, the left costal margin and the inferior margin of the left lobe of the liver.

Surface marking:
Superiorly: left sixth rib,
Laterally: left anterior axillary line,
Inferiorly: left costal margin.

Clinical Use:
Stomach lies underneath the Traube's space, which produces a tympanic sound on percussion. Percussion is carried out medial to lateral. If percussion within the confines of the Traube's space produces a dull tone, this indicates splenomegaly.

There are views ranging from "very useful" to "useful but not sensitive/ specific" in the medical literature. However, the views of individual teachers is much more wider in spectrum.

I will quote two references with links to PubMed abstracts here:
1. Percussion of Traube's space--a useful index of splenic enlargement.

Percussion of the Traube's space is a useful clinical screening test for splenomegaly, with a sensitivity of 67% and specificity of 75%, as compared to palpation (sensitivity of 44.44% and specificity of 96.87%). And maximum clinical utility is achieved when both percussion and palpation are combined.

2. Splenic enlargement and Traube's space: how useful is percussion?

Traube's space percussion compares favorably with other commonly used clinical maneuvers and diagnostic tests. When performed alone in a selected patient population, it adds useful clinical information but is not sufficiently sensitive or specific to obviate the need for further diagnostic testing.

Suggestion:
Know about it, use it, but don't be obsessed by it.

A left lung mass lesion/consolidation alone never produces impairment as lung is not extending to traube's space.

Yes, you are right elizabeth. A pleural effusion will however cause dull note in the Traube's space.

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