From the Guidelines
Splenomegaly, or enlarged spleen, can be caused by numerous conditions affecting the body, with the most common causes including infections, liver diseases, blood disorders, inflammatory conditions, and portal hypertension, as reported in a recent study 1. The spleen becomes congested with blood cells or abnormal cells, or works harder to combat infections, leading to enlargement. Symptoms may include abdominal pain or fullness in the left upper quadrant, early satiety, and sometimes shoulder pain. Diagnosis typically involves physical examination, imaging studies like ultrasound or CT scan, and laboratory tests to identify the underlying cause. Treatment focuses on addressing the primary condition rather than the splenomegaly itself, though in severe cases splenectomy (surgical removal of the spleen) may be necessary, as discussed in a study on immune thrombocytopenia 1. Some key points to consider in the management of splenomegaly include:
- The importance of identifying the underlying cause of splenomegaly, as treatment will depend on the specific condition, as highlighted in a study on chronic myeloid leukemia 1.
- The use of imaging studies, such as ultrasound or CT scan, to diagnose and monitor splenomegaly, as recommended in a study on acid sphingomyelinase deficiency 1.
- The potential benefits and risks of splenectomy, including the risk of infection, thromboembolism, and malignancy, as discussed in a study on transitioning patients with immune thrombocytopenia to second-line therapy 1.
- The importance of lifelong management and surveillance for patients who have undergone splenectomy, including vaccinations and prophylactic antibiotics, as recommended in a study on the management of patients with classic hairy cell leukemia 1. Understanding the specific cause of splenomegaly is crucial for effective management, and treatment should be tailored to the individual patient's needs, as emphasized in a study on the management of liver diseases in pregnancy 1.
From the Research
Causes of Splenomegaly
- Splenomegaly can be due to several mechanisms, but is almost always a sign of a systemic condition 2.
- The most common causes of splenomegaly in the United States are liver disease, malignancy, and infection 2.
- Malaria and schistosomiasis are common causes of splenomegaly in tropical regions, where as many as 80% of people may have splenomegaly 2.
- Hypersplenism is a common manifestation of portal hypertension in the cirrhotic, and can lead to thrombocytopenia caused by increased sequestering and breakdown of platelets in the spleen 3, 4.
- Splenomegaly can also be caused by vascular abnormalities and hemolysis 5.
Risk Factors for Splenomegaly
- Patient habits, travel, and medical conditions can increase the risk of splenomegaly and suggest etiology 2.
- Liver disease, such as cirrhosis, can increase the risk of splenomegaly 3, 4, 6.
- Infections, such as infectious mononucleosis, can also increase the risk of splenomegaly 2.
Diagnosis of Splenomegaly
- Physical examination will typically reveal splenomegaly, but abdominal ultrasonography is recommended for confirmation 2.
- Basic laboratory analysis and ultrasonography are the first-line steps in determining the etiology of splenomegaly 2.
- Lymphadenopathy and splenomegaly can be found in symptomatic or asymptomatic patients, and a diagnostic approach should consider various diseases, including infections, noninfectious inflammatory conditions, or malignancies 5.