Ballottement

Ballottement (from French ballotement - shaking, oscillation), means the shaking or oscillation of a dense, movable organ in its surrounding medium when gently tapped with the fingers of the examining hand. Under normal conditions, the phenomenon of B. can be observed in the pregnant uterus, when a fully formed fetal head, surrounded by amniotic fluid, gives a B. (shaking) of the fetal head when gently pushed by hand through the abdominal wall and uterus. The symptom of B. can be given in normal conditions by the right kidney, which usually stands somewhat lower than the left kidney and is more easily displaced during respiratory excursions of the diaphragm. If with the fingers of a hand bent at the interphalangeal joints short taps are made in the space between the lower edge of the XII rib and the iliac crest, and the palm of the other hand is placed on the abdominal wall near the costal margin, outward from the rectus muscle of the other side, then a characteristic impulse of a dense body can be felt - the lower pole of the kidney. B. of the kidney is obtained even more clearly when the organ is enlarged with preservation of its mobility. Under pathological conditions, the phenomenon of B. is most clearly obtained with the patella in hydrarthrosis of the knee joint. With short taps by the fingertips of bent fingers on the patella, the latter is pushed downward toward the articular ends of the femur and tibia and then bounces back upward (when the finger taps cease), being pushed by a layer of fluid in the knee joint. Sometimes with a significant accumulation of fluid in the knee joint, B. (bouncing) of the patella may be accompanied by a clearly audible sound of it striking the femur bones before bouncing back upward to its original position. In addition to the most typical cases mentioned above, the phenomenon of B. can be observed in the abdominal cavity with significant enlargement of the gallbladder, with the presence of movable tumors (ovarian cysts, neoplasms of the intestines, omentum and mesentery), with pathologically enlarged liver and spleen, especially when ascites simultaneously exists, etc. Ballottement of the skull, see Hydrocephalus.