What are the signs and symptoms of splenomegaly?

Signs and Symptoms of Splenomegaly

Splenomegaly presents with characteristic symptoms including abdominal pain, particularly in the left upper quadrant, fatigue, weight loss, and early satiety due to enlarged spleen compressing the stomach. 1, 2

Common Clinical Manifestations

• Abdominal pain - Typically localized to the left upper quadrant; may be described as fullness or discomfort 3
• Fatigue and weight loss - Present in up to 46% of patients with splenomegaly 3
• Fever - Observed in approximately 25% of patients, particularly in infectious causes 3
• Early satiety - Due to compression of the stomach by the enlarged spleen 1
• Left upper quadrant fullness - Physical finding on examination or reported by patient 3

Physical Examination Findings

• Palpable spleen - Most consistent physical sign, detected in 40-50% of cases 3
• Hepatomegaly - Less common but may coexist with splenomegaly 3, 2
• Jaundice and ascites - May be present in cases related to liver disease and portal hypertension 1, 2
• Splenic size measurement - Determined by measuring below the left costal margin; massive splenomegaly is defined as >10cm below costal margin 1, 4

Hematologic Manifestations

• Cytopenias - Particularly thrombocytopenia due to hypersplenism 5
• Anemia - Common finding in patients with splenomegaly 3, 5
• Leukocytosis - May be present, especially in myeloproliferative disorders 3, 4
• Bleeding tendencies - Due to thrombocytopenia and/or platelet dysfunction 3, 5

Disease-Specific Manifestations

Portal Hypertension and Liver Disease

• Esophageal varices - Complication of portal hypertension associated with chronic splenic vein thrombosis 3
• Lower extremity edema - May be present in chronic presentations 3
• Ascites - Sign of advanced liver disease with portal hypertension 1, 2

Hematologic Disorders

• Massive splenomegaly (>10cm below costal margin) - Characteristic of myelofibrosis and other myeloproliferative disorders 1, 4
• Bone and joint pain - Common in storage disorders with splenomegaly 1

Infectious Causes

• Persistent fever - May indicate splenic abscess, particularly in patients with endocarditis 1
• Guarding and rebound tenderness - May indicate progression to bowel infarction in mesenteric vein thrombosis 3

Complications of Splenomegaly

• Splenic rupture - Risk increases with size; patients should avoid contact sports 6
• Splenic infarction - Presents as sudden left upper quadrant pain 1
• Hypersplenism - Leading to cytopenias, particularly thrombocytopenia 5
• Portal vein thrombosis - Associated with poor prognosis in certain conditions 3

Diagnostic Approach

• Abdominal ultrasound - Recommended to confirm splenomegaly and assess for other abdominal pathology 1, 2
• Complete blood count - To assess for cytopenias (anemia, thrombocytopenia, leukopenia) 1, 2
• CT angiography or MRV - May be needed to evaluate vascular structure and potential complications 3

Pitfalls in Evaluation

• Splenomegaly may be asymptomatic, especially in chronic cases due to formation of collateral veins 3
• Physical examination alone may miss splenomegaly; imaging confirmation is recommended 6
• Massive splenomegaly may be mistaken for other abdominal masses; proper imaging is essential 4
• Patients with splenomegaly are at increased risk for splenic rupture with even minor trauma 6, 7