From the Guidelines
An enlarged spleen measuring 16 cm on CT scan is clinically significant and requires immediate further evaluation to determine the underlying cause and prevent potential complications, such as rupture or hemorrhage, which can significantly impact morbidity, mortality, and quality of life. Normal spleen size is typically less than 13 cm in craniocaudal (cc) dimension. This finding may indicate underlying conditions such as infections (viral, bacterial, parasitic), hematologic disorders (leukemia, lymphoma, myeloproliferative disorders), liver disease with portal hypertension, inflammatory conditions, or storage diseases. According to the guidelines for splenic trauma, a CT scan with intravenous contrast is the gold standard in hemodynamically stable or stabilized patients 1. The patient should undergo a complete blood count, liver function tests, and possibly additional imaging or specialist consultation with a hematologist or gastroenterologist. Some key points to consider in the evaluation of splenomegaly include:
- The choice of diagnostic technique at admission must be based on the hemodynamic status of the patient 1
- E-FAST is effective and rapid to detect free fluid, but CT scan is more sensitive and specific for splenic injuries 1
- Doppler US and contrast-enhanced US are useful to evaluate splenic vascularization and in follow-up 1 Physical examination should assess for other signs of liver disease, lymphadenopathy, or systemic illness. The spleen's enlargement occurs because it serves as a filter for blood, removing old red blood cells and responding to infections; when these functions are stressed by disease processes, the spleen can enlarge significantly. While some cases of mild splenomegaly may be monitored, a 16 cm spleen warrants investigation to identify and treat the underlying cause. Patients should be advised to avoid contact sports or activities with high risk of abdominal trauma, as an enlarged spleen is more vulnerable to rupture.
From the Research
CT Findings of Enlarged Spleen
- An enlarged spleen, also known as splenomegaly, can be a sign of a systemic condition 2, 3, 4
- The spleen is the largest immune organ in the human body and plays a crucial role in red blood cell homeostasis and iron recycling 3
- Splenomegaly can occur as a physiological response to stress or as a chronic process that is often detrimental to the wellbeing of the individual 3
Diagnosis and Management
- Abdominal ultrasonography is recommended for confirmation of splenomegaly, and physical examination should assess for signs of systemic illness, liver disease, and anemia or other hematologic issues 2
- Basic laboratory analysis and ultrasonography are the first-line steps in determining the etiology of splenomegaly, except for apparent causes such as infectious mononucleosis 2
- Management of splenomegaly involves treating the underlying disease process, and splenectomies and spleen reduction therapies are sometimes performed 2
CT Scan Findings
- A study found that the coefficient calculated from maximal length, vertical height, and hilum thickness correlates the strongest with spleen volume and can be utilized for monitoring of spleen volume 5
- The same study found that a two-dimensional coefficient (maximal length × vertical height) with a cut-off of 115 cm2 is suitable for quick splenomegaly screening 5
- Another study compared the value of US and CT for the detection and analysis of splenic abnormalities and found that US was more sensitive than CT in the detection of malignant lesions, particularly splenic lymphoma 6
Significance of Enlarged Spleen 16 cm
- A spleen size of 16 cm is considered enlarged, and the underlying cause should be investigated 2, 3, 4
- The significance of an enlarged spleen 16 cm can vary depending on the underlying cause, and further evaluation and management should be guided by the patient's clinical presentation and laboratory results 2, 3, 4