Puddle sign

In gastroenterology, the puddle sign is a physical examination maneuver that can be used to detect the presence of ascites. It is useful for detecting small amounts of ascites—as small as 120 mL; shifting dullness and bulging flanks typically require 500 mL.

The steps are outlined as follows:

In relation to auscultatory percussion, the puddle sign is more specific, but less sensitive.