From the Research
The normal liver span below the costovertebral angle margin is not a standard clinical measurement, and instead, liver size is typically measured at the midclavicular line, where the normal liver span ranges from 6-12 cm in adults. When examining the liver, clinicians typically percuss and palpate along the right midclavicular line, starting from below the umbilicus and moving upward to detect the liver edge. The liver is normally palpable 0-2 cm below the right costal margin (not the costovertebral angle, which is located posteriorly at the junction of the ribs and spine) 1. The costovertebral angle is more commonly used to assess for kidney tenderness rather than liver measurements. Liver size varies based on body habitus, with taller individuals typically having larger livers. An enlarged liver extending significantly below the costal margin may indicate hepatomegaly from conditions such as fatty liver disease, hepatitis, heart failure, or malignancy.
Some key points to consider when assessing liver size include:
- The liver span can be estimated by clinical, radiological, or radioisotopic methods, but these methods may not always provide accurate information regarding the actual volume of the organ 2.
- The agreement between physical and ultrasonographic assessment of the liver span below the costal margin was poor in controls but excellent in patients with cirrhosis 1.
- Liver volume proved to predict prognosis in patients with cirrhosis, but its measurement needs quantitative, reproducible methods, which can be obtained only by imaging techniques 1.
- More reliable sequential estimates of liver size are likely to be obtained using measurements both in the midline and in a well-defined and agreed point below the right costal margin 3.
In clinical practice, accurate assessment of liver size is important for detecting pathological conditions and monitoring disease progression, and clinicians should use a combination of physical examination and imaging techniques to estimate liver size and detect any abnormalities 1.