From the Guidelines
Splenomegaly can be caused by a variety of conditions, including infections, blood disorders, liver diseases, autoimmune disorders, metabolic disorders, cancers, trauma, and cysts or tumors, with the most common causes being infections such as mononucleosis and malaria, and blood disorders like leukemia and lymphoma. When considering the causes of splenomegaly, it is essential to take into account the patient's medical history, physical examination, and laboratory results. Some of the key causes of splenomegaly include:
- Infections: Viral infections like mononucleosis 1, bacterial infections like endocarditis, and parasitic infections like malaria and leishmaniasis 1
- Blood disorders: Leukemia, lymphoma, sickle cell disease, and other hemolytic anemias 1
- Liver diseases: Cirrhosis, portal hypertension
- Autoimmune disorders: Lupus, rheumatoid arthritis
- Metabolic disorders: Gaucher's disease, Niemann-Pick disease
- Cancers: Especially those affecting the lymphatic system
- Trauma: Physical injury to the spleen
- Cysts or tumors: Benign growths within the spleen It is crucial to identify the underlying cause of splenomegaly, as the treatment approach varies depending on the cause. A thorough diagnostic evaluation, including laboratory tests and imaging studies, is necessary to determine the cause of splenomegaly and guide treatment. In some cases, splenomegaly may be asymptomatic, while in others, it can cause symptoms such as abdominal pain, fatigue, and weight loss. The management of splenomegaly depends on the underlying cause, and treatment options may include medications, surgery, or other interventions. For example, in cases of splenomegaly caused by leukemia or lymphoma, treatment may involve chemotherapy, radiation therapy, or targeted therapy 1. In contrast, splenomegaly caused by infections such as leishmaniasis may require antiparasitic medications 1. Ultimately, the goal of treatment is to manage the underlying cause of splenomegaly, alleviate symptoms, and improve quality of life.
From the Research
Causes of Splenomegaly
- Splenomegaly can occur as a result of various pathological conditions, including primary blood diseases and other clinical disorders of different etiology 2
- The spleen's structure and function, including filtration, immunological function, and extramedullary hematopoiesis, can be affected by various diseases, leading to splenomegaly 2, 3
- Non-tumorous disorders, such as portal hypertension due to liver cirrhosis, can also cause splenomegaly 4, 5
- Tumor involvement, such as primary splenic lymphoma, can also lead to splenomegaly 4
- Hepatic diseases, infections, and hematological disorders can also cause splenomegaly 3, 6
Pathophysiological Bases of Splenomegaly
- The spleen's ability to expand and contract allows it to fulfill its functions, but pathological conditions can result in excessive expansion, leading to splenomegaly 3
- The development of portal hypertension due to liver cirrhosis can lead to splenomegaly and hypersplenism, which can facilitate the progression of liver fibrosis to cirrhosis 5
- The mechanistic contributions of splenomegaly and hypersplenism to the development of liver cirrhosis include hepatic fibrogenesis, hepatic immune microenvironment dysregulation, and liver regeneration 5
Diagnostic and Therapeutic Options
- Accurate diagnosis and evaluation of splenomegaly are essential for effective treatment, and point shear wave elastography (pSWE) has been shown to be an effective, non-invasive tool for assessing spleen stiffness 6
- Therapeutic options for splenomegaly include splenectomy, which can be performed under videolaparoscopic control, and novel potential usage of nanomedicine in non-surgically targeting splenic disorders for the treatment of liver cirrhosis 2, 5