From the Guidelines
Splenomegaly, or enlarged spleen, is most commonly caused by infections, hematologic disorders, liver diseases, inflammatory conditions, storage diseases, and certain cancers that metastasize to the spleen, as evidenced by recent studies 1. The causes of splenomegaly can be broadly categorized into several disease categories, including:
- Infections such as mononucleosis, malaria, tuberculosis, and bacterial endocarditis, which can cause splenic enlargement through increased immune activity and white blood cell proliferation 1
- Hematologic disorders like leukemias, lymphomas, hemolytic anemias, and myeloproliferative disorders, which result in splenomegaly due to extramedullary hematopoiesis or abnormal cell accumulation 1
- Liver diseases such as cirrhosis and portal hypertension, which can lead to splenomegaly as blood backs up into the splenic vein 1
- Inflammatory conditions like rheumatoid arthritis and systemic lupus erythematosus, which trigger splenic enlargement through chronic inflammation and increased immune cell activity 1
- Storage diseases such as Gaucher's disease and Niemann-Pick disease, which can cause hepatosplenomegaly due to the accumulation of toxic substances in the spleen and liver 1
- Certain cancers that metastasize to the spleen, which can cause splenomegaly through direct invasion and destruction of splenic tissue. Patients with splenomegaly may experience left upper quadrant pain, early satiety, or be completely asymptomatic, and diagnosis typically requires physical examination, imaging studies, and laboratory tests to identify the underlying cause, which then guides appropriate treatment 1. It is essential to note that the clinical presentation of splenomegaly can vary widely, and a thorough diagnostic workup is necessary to determine the underlying cause and develop an effective treatment plan. The most recent and highest quality studies, such as those published in 2017 1, provide the most reliable guidance for diagnosing and managing splenomegaly, and should be consulted when making clinical decisions.
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, which is one of the most common causes of splenomegaly in the United States 2
- Malignancy, which can lead to splenomegaly due to the spread of cancer cells to the spleen 2, 3
- Infection, such as malaria and schistosomiasis, which are common in tropical regions and can cause splenomegaly in up to 80% of the population 2
- Hematologic disorders, such as blood diseases that affect the spleen's function and lead to its enlargement 4, 5
- Other conditions, such as hypersplenism and coagulation abnormalities, which can occur in patients with liver disease and lead to splenomegaly 6
Pathophysiological Bases of Splenomegaly
Splenomegaly can occur as a physiological response to stress or as a chronic process that is often detrimental to the individual's wellbeing 5. The spleen's ability to expand and contract allows it to fulfill its functions, including filtration, immunological function, and blood storage 4, 5. However, pathological conditions can disrupt these functions and lead to splenomegaly.
Diagnostic Approaches
Diagnosing the underlying cause of splenomegaly is crucial for effective management. A logical approach to diagnosis includes:
- Physical examination to assess for signs of systemic illness, liver disease, and anemia or other hematologic issues 2, 3
- Laboratory tests, such as blood counts and liver function tests, to identify potential causes of splenomegaly 2, 3
- Imaging studies, such as abdominal ultrasonography, to confirm the presence of splenomegaly and assess its severity 2, 3