From the Guidelines
Splenomegaly is a condition that requires prompt evaluation and management to prevent complications, and the treatment should focus on addressing the underlying cause rather than the splenomegaly itself, with splenectomy considered in severe cases 1.
Causes and Diagnosis
Splenomegaly can result from various underlying causes including infections, liver diseases, blood disorders, inflammatory conditions, and metabolic disorders. Diagnosis typically involves physical examination, where the enlarged spleen may be palpable below the left ribcage, along with imaging studies such as ultrasound, CT scan, or MRI.
- Infections like mononucleosis, malaria, or tuberculosis
- Liver diseases such as cirrhosis, portal hypertension
- Blood disorders like leukemia, lymphoma, hemolytic anemia
- Inflammatory conditions like sarcoidosis, lupus
- Metabolic disorders like Gaucher's disease
Treatment and Management
Treatment focuses on addressing the underlying cause rather than the splenomegaly itself. In severe cases where the spleen becomes extremely enlarged or causes complications like platelet sequestration, splenectomy (surgical removal of the spleen) might be considered.
- Hydroxyurea is currently the first-line treatment of choice in PMF-associated splenomegaly 1
- Splenic radiation is only of transient benefit, and splenectomy remains a viable treatment option for drug-refractory splenomegaly 1
- Patients with splenomegaly should avoid contact sports and activities with high risk of abdominal trauma, as an enlarged spleen is more vulnerable to rupture, which constitutes a medical emergency requiring immediate attention.
Complications and Prognosis
Splenomegaly can lead to complications such as platelet sequestration, and in severe cases, splenic rupture, which is a medical emergency. The prognosis depends on the underlying cause and the effectiveness of treatment.
- Platelet sequestration
- Splenic rupture
- Infection
- Bleeding disorders In summary, splenomegaly requires a comprehensive evaluation and management approach, focusing on the underlying cause, and considering splenectomy in severe cases, to prevent complications and improve patient outcomes 1.
From the Research
Definition and 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 in tropical regions, where as many as 80% of people may have splenomegaly 2.
Diagnosis and Investigation
- 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 etiology, except for apparent causes such as infectious mononucleosis 2.
- In some patients, extensive radiological and laboratory investigations will fail to yield a diagnosis, resulting in "isolated" splenomegaly 3.
Management and Complications
- Management of splenomegaly involves treating the underlying disease process 2.
- Splenectomies and spleen reduction therapies are sometimes performed 2.
- Acute infections, anemia, and splenic rupture are the most common complications of splenomegaly 2.
- People with splenomegaly should refrain from participating in contact sports to decrease risk of rupture 2.
- Splenic artery aneurysms can present in the setting of portal hypertension and splenomegaly, and may require splenic artery embolization and creation of a portosystemic shunt followed by a splenectomy 4.