Splenomegaly

Splenomegaly: Excerpt from In a Page: Signs and Symptoms

The spleen is the largest lymphatic organ of the body. Splenomegaly, or enlargement of the spleen, occurs when the spleen exceeds 12 cm in length, 7 cm in width, or 150 g in mass. Although a normal spleen is not usually palpable, dullness can be percussed between the ninth and eleventh ribs (Traube's space) with the patient lying on the right side. Palpation is best performed with the patient supine with knees flexed. The spleen is best felt as it descends during inspiration. However, physical diagnosis is not sensitive.

Differential Diagnosis

• Mononucleosis
• Congestive heart failure
• Portal hypertension
  –Most often secondary to cirrhosis
• Hepatitis
• Hereditary spherocytosis
• Sickle cell disease
• Thalassemia major
• Polycythemia vera
• Malaria
• Tuberculosis
• Other infections: Mycobacterium avium complex, HIV, CMV, RMSF
• Endocarditis
• Malignancy (e.g., leukemia, lymphoma, metastases)
• 
  –Massive enlargement of the spleen usually signifies a lymphoproliferative or myeloproliferative disorder
• Systemic lupus erythematosus
• Felty's syndrome (rheumatoid arthritus, splenomegaly, and granulocytopenia)
• Splenic hemangioma, hamartoma, or cyst
• Trauma
• Splenic vein thrombosis
• Less common causes (“zebras”) include Gaucher's disease, amyloidosis, kala-azar (visceral leishmaniasis), schistosomiasis, rickets, syphilis, babesiosis, typhoid fever, histoplasmosis, and toxoplasmosis

Workup and Diagnosis

• History and physical examination
• CBC with differential cell counts
  –Decreases in one or more cell lineages may indicate hypersplenism
  –Neutrophilia suggests infection
• Examination of the peripheral smear
  –Atypical lymphocytes suggest mononucleosis
  –Spherocytes suggest hereditary spherocytosis
  –Teardrop-shaped RBCs suggest bone marrow invasion
• Further laboratory studies may include electrolytes, BUN/creatinine, urinalysis, chest X-ray, ANA, rheumatoid factor, HIV testing, and sickle cell prep
• Abdominal CT or ultrasound better delineate the splenomegaly and may reveal associated abdominal pathology
• Bone marrow biopsy may be indicated to evaluate for leukemia, myelofibrosis, and/or infection
• Biopsy, fine needle aspirate, and/or splenectomy may be necessary

Treatment

• Infectious etiologies require appropriate antibiotic regimens
• Leukemia and lymphoma are treated with combination chemotherapy
• Systemic lupus erythematosus and rheumatoid arthritis are treated with steroids and/or cytotoxic agents
• Hemolytic anemia is treated with steroids
• Splenectomy may be required for patients with traumatic spleen injury with persistent bleeding; patients without a spleen are at increased risk of sepsis and should receive regular pneumococcal and Haemophilus influenzae vaccinations

Book Source Details

• Book Title: In a Page: Signs and Symptoms
• Author(s): Scott Kahan, Ellen G. Smith
• Year of Publication: 2004
• Copyright Details: In a Page: Signs and Symptoms, Copyright © 2004 Lippincott Williams & Wilkins.

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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.

More About This Book: Title: In a Page: Signs and Symptoms Authors: Scott Kahan, Ellen G. Smith Publisher: Lippincott Williams & Wilkins Copyright: 2004 ISBN: 1-4051-0368-X

 » Next page: Arthritis – Multiple Joints (In A Page: Pediatric Signs and Symptoms)

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