Splenomegaly


 * Gichoya Judy Wawira [mailto:judywawira@gmail.com], Moi University School of Medicine

Overview
Splenomegaly is an enlargement of the spleen, which usually lies in the left upper quadrant (LUQ) of the human abdomen. It is one of the four cardinal signs of hypersplenism, the other three being cytopenia(s), normal or hyperplastic bone marrow, and a response to splenectomy. Splenomegaly is usually associated with increased workload (such as in hemolytic anemias), which suggests that it is a response to hyperfunction. It is therefore not surprising that splenomegaly is associated with any disease process that involves abnormal red blood cells being destroyed in the spleen. Other common causes include congestion due to portal hypertension and infiltration by leukemias and lymphomas.

Complete differential diagnosis splenomegaly in alphabetical order
In alphabetical order.


 * AIDS
 * Angioimmunoblastic lymphoanedopathy
 * Angiosarcoma
 * Autoimmune hemolytic anemia
 * Bacterial septicemia
 * Bone marrow damage
 * Bone marrow infiltration
 * Brucellosis
 * Castleman's syndrome
 * Cavernous transformation of the portal vein
 * Cellular infiltration
 * Chronic myoletic leukemia
 * Collagen vascular diseases
 * Congestive heart failure
 * Constrictive pericarditis
 * Coronavirus
 * Corynebacterium diphtheriae
 * Cytomegalovirus
 * Early sickle cell anemia
 * Endocarditis
 * Ehrlichiosis
 * Eosinophillic granuloma
 * Epstein-Barr Virus Infection
 * Felty's syndrome
 * Fever unknown origin
 * Fibromas
 * Fungal infections
 * Gaucher's disease
 * Hemangiomas
 * Hamartomas
 * Hemoglobinopathy
 * Hemolytic anemia
 * Hepatic echinococcosis
 * Hepatic schistomasis
 * Hepatic vein obstruction
 * Hepatitis
 * Hereditary spherocytosis
 * Histiocytosis
 * Histoplasmosis
 * HIV
 * Hodgkin's lymphoma
 * Hurler's syndrome
 * Hyperlipidemias
 * Idiopathic splenomegaly
 * Immune hemolytic anemias
 * Infective Endocarditis
 * Infectious mononucleosis
 * Interleukin-2
 * Iron deficiency anemia
 * Leishmaniasis
 * Letterer-Siwe disease
 * Leukemia
 * Lymphangiomas
 * Lymphoid leukemia
 * Lympho-reticulosarcoma
 * Malaria
 * Malignancy
 * Melanoma
 * Myelofibrosis
 * Myeloid leukemia
 * Myeloid metaplasia
 * Monocytic leukemia
 * Mononucleosis
 * Myobacterium avium complex
 * Myoproliferative syndrome(s)
 * Niemann-Pick disease
 * Non-Hodgkin's lymphoma
 * Nutritional anemias
 * Osteomyelosclerosis
 * Paroxysmal nocturnal hemoglobinuria
 * Polycythemia vera
 * Portal hypertension
 * Q fever
 * Radiation
 * Rheumatoid arthritis
 * RMSF
 * Sarcoidosis
 * Schistosomiasis
 * Serum sickness
 * Sickle cell disease
 * Splenic abscess
 * Splenic artery anuerysm
 * Splenic cysts
 * Splenic hamartoma
 * Splenic hemangioma
 * Splenic vein obstruction/thrombosis
 * Stillness disease
 * Subacute bacterial endocarditis
 * Syphillis
 * Systemic lupus erythematosus
 * Tangier disease
 * Thalassemia major
 * Thyrotoxicosis
 * Toxoplasmosis
 * Trauma
 * Trypanosomiasis
 * Tuberculosis
 * Tumors
 * Typhoid fever
 * Vein obstruction
 * Viral hepatitis
 * Weil's disease
 * Less common causes 
 * Amyloidosis
 * Babesiosis
 * Gaucher's disease
 * Histoplasmosis
 * Kala-azar
 * Rickets
 * Schistosomiasis
 * Syphilis
 * Toxoplasmosis
 * Typhoid fever

Differential diagnosis of causes by organ system or pathogenesis
Splenomegaly grouped on the basis of the pathogenic mechanism

The causes of massive splenomegaly (>1000gms) are much fewer and include:

Thalassemia Kala-Azar (Leishmaniasis) Portal hypertension of Bilharziasis Chronic myelogenous leukemia lymphomas hairy cell leukemia myelofibrosis polycythemia vera Gauchers disease chronic lymphocytic leukemia sarcoidosis autoimmune hemolytic anemia Malaria

Clinical presentation
Symptoms may include abdominal pain, early satiety due to splenic encroachment, or the symptoms of anemia due to accompanying cytopenia.

Signs of splenomegaly may include a palpable left upper quadrant abdominal mass or splenic rub. It can be detected on physical examination by using Castell's sign or Traube's space, but an ultrasound can be used to confirm diagnosis.

Treatment
If the splenomegaly underlies hypersplenism, a splenectomy is indicated and will correct the problem. After splenectomy, however, patients have an increased risk for infectious diseases.

After splenectomy, patients should be vaccinated against Haemophilus influenzae and Streptococcus pneumoniae. They should receive annual influenza vaccinations. Long-term prophylactic antibiotics should be given.

Related chapters

 * sign (medicine)
 * Hepatosplenomegaly

Resources

 * PatientPlus Splenomegaly and hypersplenism
 * (Hypersplenism)