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Splenomegaly
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Splenomegaly

Splenomegaly
Enlargement of the spleen in size or weight.
Normal adult spleen weighs 70 g to 200 g. Splenic weight of 400 g to 500 g indicates splenomegaly.
  • Massive splenomegaly = >1000 g
Normal adult spleen measures up to 12 cm in length. Splenic length of 12 cm to 20 cm indicates splenomegaly.
  • Massive splenomegaly >20 cm.
Anatomical position of the spleen is within the peritoneal cavity, in the LUQ (adjacent to ribs 9 through 12).
abdominal ct scan, spleen
SIGNS & SYMPTOMS
Vague abdominal discomfort, especially in left upper abdominal quadrant. Early satiety, due to spleen pushing on stomach.
Underlying disorders account for additional symptoms, such as bleeding or severe, sudden pain.
  • Splenic friction rub and shoulder pain suggest splenic infarction.
  • Hemolytic disorders present with signs of anemia, easy bruising and bleeding.
TOP CAUSES OF SPLENOMEGALY
Temperate climates:
  • Connective tissue disorders
  • Hepatic cirrhosis with portal hypertension
  • Hemolytic anemias
  • Infections
    • Hepatitis, mononucleosis
  • Infiltrative diseases
    • Fatty liver, sarcoidosis, amyloidosis, hemochromatosis
  • Lymphoproliferative disorders
  • Myeloproliferative neoplasms
  • Chronic myeloid leukemia
Tropical climates:
  • Infectious diseases
    • Malaria, visceral leishmaniasis, schistosomiasis
Massive Splenomegaly Top causes:
  • Chronic lymphocytic leukemia
  • Chronic myeloid leukemia
  • Gaucher disease
  • Hairy cell leukemia
  • Non-Hodgkin lymphoma
  • Polycythemia vera
  • Primary myelofibrosis
Splenic sequestration crisis
Watch for splenic sequestration, which is a complication of sickle cell anemia mostly seen in children.
SSC is caused by red blood cells trapped in the spleen, leading to a potentially lethal drop in the circulating blood volume.
TYPES BY ETIOLOGY
Congestive: when the spleen is enlarged due to pooled blood (as in portal hypertension).
Infiltrative: when the spleen is invaded by foreign cells, etc. (as in metastasis, myeloid neoplasm, and lipid storage disease).
Immune: when the spleen is enlarged due to an increase in immunologic activity (as seen in subacute endocarditis, sarcoidosis, or rheumatoid arthritis).
Neoplastic: when the enlargement is due to neoplasm (eg., lymphoma).
SPLENIC ROLES
Review the Anatomy & Histology of the Spleen
Hematopoiesis & Immunosurveillance:
  • Platelet storage
  • Clearance of abnormal erythrocytes (review removal of RBC here).
  • Removal of microorganisms and antigens.
  • Secondary lymphoid organ and is the site for the maturation and storage of T and B lymphocytes.
  • Immunoglobulin G (IgG) synthesis.

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