Normal Spleen Size in Adults and Children
Adult Spleen Dimensions
The normal spleen size in adults is defined as a vertical length of 13 cm or less when measured in the coronal plane. 1
Standardized Measurement Parameters
- Length ≤13 cm is the primary criterion for normal spleen size in adults, as established by the American College of Radiology and European Society for Medical Oncology 1
- Measurement should be performed in the coronal plane as a vertical length using CT scan, ultrasound, or PET/CT 1
- Research data supports slightly lower mean values: ultrasound studies show mean splenic length of 10.68 cm in adults, with males having larger dimensions than females 2
Clinical Thresholds for Splenomegaly
- 11-13 cm: Mild splenomegaly 1
- >13 cm: Clinically significant splenomegaly requiring further evaluation 1
- CT-based measurements show that craniocaudal length >9.5 cm and width >10.6 cm may serve as upper cutoff limits for normal spleen 3
Important Considerations for Adults
- Normal spleen size varies based on race, body size, and height 1
- Spleen volume correlates most strongly with height (r=0.655) and weight (r=0.643), with weaker correlations to age and BMI 2
- A normal-sized spleen does not exclude pathology (e.g., lymphoma can occur in normal-sized spleens) 1
- Physical examination alone is unreliable for detecting mild to moderate splenomegaly; imaging is essential 1
Pediatric Spleen Dimensions
Spleen size in children increases progressively with age, and age-specific cutoffs must be used rather than applying adult standards.
Age-Specific Upper Limits of Normal Splenic Length
The following represent maximum normal splenic lengths measured sonographically in the coronal plane at the hilum 4:
- 3 months: ≤6.0 cm 4
- 6 months: ≤6.5 cm 4
- 12 months: ≤7.0 cm 4
- 2 years: ≤8.0 cm 4
- 4 years: ≤9.0 cm 4
- 6 years: ≤9.5 cm 4
- 8 years: ≤10.0 cm 4
- 10 years: ≤11.0 cm 4
- 12 years: ≤11.5 cm 4
- 15+ years (girls): ≤12.0 cm 4
- 15+ years (boys): ≤13.0 cm 4
Measurement Technique in Children
- Obtain a coronal view that includes the hilum while the patient breathes quietly 4
- Measure the greatest longitudinal distance between the dome of the spleen and the tip 4
- This single-measurement technique is simple, reproducible, and clinically validated 4
Clinical Implications for Pediatric Splenomegaly
- Abdominal ultrasound should be obtained to confirm splenomegaly, as physical examination is unreliable in children 5
- Activity restriction of 4-6 weeks is recommended for mild splenomegaly based on trauma literature 5
- Repeat ultrasound at 4-6 weeks if splenomegaly persists or concerning symptoms develop 5
Common Pitfalls in Spleen Size Assessment
- Do not rely on physical examination alone for detecting splenomegaly in either adults or children 1, 5
- Do not assume a normal-sized spleen excludes disease—lymphoma and other pathologies can occur without enlargement 1
- In children with splenomegaly and thrombocytopenia, do not assume ITP; significant splenomegaly suggests alternative diagnoses including acute leukemia 5
- Always obtain a peripheral blood smear in children with splenomegaly and cytopenias to exclude acute leukemia 5
- Splenic enlargement may result from non-pathological causes such as blood volume variations or hematopoietic growth factor use 1