From the Guidelines
Splenomegaly, or enlargement of the spleen, has numerous causes that can be categorized into several groups, including infections, hematologic disorders, congestive causes, inflammatory conditions, storage diseases, and primary splenic disorders. The causes of splenomegaly can be diverse and multifactorial. Some of the key causes include:
- Infections such as bacterial infections like endocarditis and tuberculosis, viral infections such as mononucleosis (EBV), HIV, and CMV, and parasitic infections like malaria and leishmaniasis 1
- Hematologic disorders like hemolytic anemias, leukemias (particularly CLL and hairy cell leukemia), lymphomas (Hodgkin's and non-Hodgkin's), and myeloproliferative disorders like polycythemia vera and myelofibrosis 1
- Congestive causes such as portal hypertension from liver cirrhosis, heart failure, or splenic vein thrombosis 1
- Inflammatory conditions like rheumatoid arthritis, systemic lupus erythematosus, and sarcoidosis 1
- Storage diseases such as Gaucher's disease, Niemann-Pick disease, and amyloidosis 1
- Primary splenic disorders like splenic cysts, hemangiomas, and abscesses 1 Evaluation of splenomegaly should include a thorough history, physical examination, complete blood count, liver function tests, and often imaging studies like ultrasound or CT scan to determine the underlying cause, as treatment is directed at the specific etiology rather than the splenomegaly itself. It is essential to consider the most recent and highest quality studies when evaluating the causes of splenomegaly, and the most recent study 1 highlights the importance of spleen elastography in assessing portal hypertension, which can lead to splenomegaly. In clinical practice, it is crucial to prioritize the underlying cause of splenomegaly and direct treatment accordingly, rather than solely focusing on the splenomegaly itself.
From the Research
Causes of Splenomegaly
The causes of splenomegaly can be diverse and are often related to systemic conditions. Some of the common causes include:
- Liver disease, malignancy, and infection, which are the most common causes in the United States 2
- Malaria and schistosomiasis, which are common in tropical regions 2, 3
- Vascular abnormalities and hemolysis 4
- Sickle cell disease, particularly in malaria-endemic regions 5
- Infectious mononucleosis 2
- Noninfectious inflammatory conditions 4
Systemic Conditions Associated with Splenomegaly
Splenomegaly can be associated with various systemic conditions, including:
- Hepatic conditions, such as liver disease 2
- Hematologic conditions, such as anemia or other hematologic issues 2
- Malignant conditions, such as cancer 2, 4
- Infectious conditions, such as malaria or schistosomiasis 2, 3
Geographic Variations in Splenomegaly Causes
The causes of splenomegaly can vary depending on the geographic region. For example: