Splenomegaly

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Contents 1 Introduction 2 Etiology 3 Pathology 4 Clinical-manifestations 5 Laboratory 6 Radiology 7 Management 8 More General Terms 9 Additional Terms 10 References

Introduction

• Enlargement of the spleen.

Etiology

• (also see 'expanded causes of splenomegaly')
• massive splenomegaly

• Gaucher's disease
• myelofibrosis with myeloid metaplasia
• chronic myeloid leukemia
• portal hypertension

• hepatic cirrhosis

• splenic cyst
• non-Hodgkin's lymphoma
• hairy cell leukemia
• chronic lymphocytic leukemia
• polycythemia rubra vera
• sarcoidosis
• autoimmune hemolytic anemia

• other causes (see 'expanded causes of splenomegaly')

• extravascular hemolytic anemia
• amyloidosis
• extramedullary hematopoeisis
• autoimmune disorders

Pathology

• dilutional effect from expansion of plasma volume that accompanies splenomegaly
• pooling of cells in spleen
• serious bleeding or infectious complications are rare
• splenomegaly itself does not cause increased destruction of normal cells

Clinical-manifestations

• dullness to percussion in Traube's space
• may be painful
• early satiety with massive splenomegaly

Laboratory

• complete blood count ( CBC) with peripheral smear

• mild to moderate pancytopenia

• platelet count is affected most

• bone marrow aspiration & biopsy
• chemistry panel

• liver function tests
• renal function tests

Radiology

• computed tomography to evaluate anatomy of spleen [4]
• ultrasound with doppler to evaluate flow through portal & splenic vein
• technetium liver-spleen scan

• in chronic liver disease there is a redistribution of technetium from the liver to the bone marrow & spleen

Management

• splenectomy

• diagnosis if other diagnostic measures do not provide diagnosis
• therapeutic

More General Terms

• hypersplenism

Additional Terms

• causes of splenomegaly
• chronic lymphocytic leukemia (CLL)
• Gaucher's disease
• hairy cell leukemia
• myeloid metaplasia
• non-Hodgkin's lymphoma
• polycythemia rubra vera (PRV, PV, erythremia)
• portal hypertension
• sarcoidosis
• Traube's space

References

1. Mayo Internal Medicine Board Review, 1998-99, Prakash UBS (ed) Lippincott-Raven, Philadelphia, 1998, pg 45
2. Medical Knowledge Self Assessment Program (MKSAP) 11, American College of Physicians, Philadelphia 1998
3. Harrison's Principles of Internal Medicine, 14th ed. Fauci et al (eds), McGraw-Hill Inc. NY, 1998, pg 350
4. Veterans Administration, Dept of Radiology

splenomegaly