From the Guidelines
Splenomegaly is caused by various conditions that lead to increased workload, congestion, or infiltration of the spleen, including infections, liver diseases, blood disorders, inflammatory conditions, and storage disorders. The spleen enlarges as it works harder to filter blood, fight infections, or becomes congested with blood cells or abnormal substances. Common causes of splenomegaly include:
- Infections like mononucleosis, malaria, and bacterial endocarditis 1
- Liver diseases such as cirrhosis and portal hypertension 1
- Blood disorders like hemolytic anemias, leukemias, and lymphomas 1
- Inflammatory conditions like rheumatoid arthritis and lupus
- Storage disorders such as Gaucher's disease 1 Physical examination may reveal a palpable spleen below the left ribcage, and patients might experience left upper quadrant pain, early satiety, or fatigue. Diagnosis typically involves physical examination, blood tests, and imaging studies like ultrasound or CT scan. Treatment focuses on addressing the underlying cause rather than the splenomegaly itself. In severe cases where the spleen becomes extremely enlarged or causes complications, surgical removal (splenectomy) may be necessary, though this is avoided when possible due to the spleen's important immune functions 1.
From the Research
Causes of Splenomegaly
- Splenomegaly can be due to several mechanisms, but is almost always a sign of a systemic condition 2
- The most common causes of splenomegaly in the United States are liver disease, malignancy, and infection 2
- Malaria and schistosomiasis are common causes of splenomegaly in tropical regions, where as many as 80% of people may have splenomegaly 2
- Infectious mononucleosis, caused by Epstein-Barr virus, can also lead to splenomegaly, with approximately 50% of cases resulting in splenomegaly 3
- Other causes of splenomegaly include hematologic disorders, such as lymphoma and leukemia, and hepatic disorders, such as cirrhosis and portal hypertension 4, 5
Pathophysiological Bases of Splenomegaly
- The spleen is the largest immune organ in the human body and is essential for red blood cell homeostasis and iron recycling 5
- Pathological conditions can result in the spleen expanding, leading to splenomegaly, which can occur as a physiological response to stress or as a chronic process that is often detrimental to the wellbeing of the individual 5
- The role of the spleen in filtering and destroying senescent red blood cells, infectious microorganisms, and Plasmodium-parasitized RBCs is critical in the development of splenomegaly, particularly in cases of malaria infection 6
Risk Factors for Splenomegaly
- Patient habits, travel, and medical conditions can increase the risk of splenomegaly and suggest etiology 2
- Infection with certain pathogens, such as Epstein-Barr virus and Plasmodium, can increase the risk of splenomegaly 3, 6
- Certain geographic locations, such as tropical regions, can also increase the risk of splenomegaly due to the prevalence of infectious diseases such as malaria and schistosomiasis 2, 6