From the Guidelines
Splenomegaly is a condition that requires careful management, focusing on treating the underlying cause, and in severe cases, considering splenectomy or other interventions to alleviate symptoms and prevent complications, as recommended by the most recent guidelines 1.
Definition and Causes
Splenomegaly refers to an abnormal enlargement of the spleen, typically detected during physical examination or through imaging studies. The spleen normally measures about 11-14 cm in length and weighs around 150 grams, with enlargement diagnosed when it exceeds these parameters. Common causes include infections (like mononucleosis, malaria, or tuberculosis), liver diseases (cirrhosis, portal hypertension), blood disorders (hemolytic anemia, leukemia, lymphoma), inflammatory conditions (sarcoidosis, lupus), and storage diseases (Gaucher's disease).
Symptoms and Management
Symptoms may include abdominal pain or fullness in the left upper quadrant, early satiety, and sometimes shoulder pain. Management depends on identifying and treating the underlying cause rather than the splenomegaly itself. For instance, antibiotics for bacterial infections, antiviral medications for viral infections, or chemotherapy for blood cancers. In severe cases where the spleen is significantly enlarged and causing complications like hypersplenism (excessive destruction of blood cells), splenectomy (surgical removal of the spleen) might be considered, as supported by recent studies 1. However, this is generally avoided when possible due to the spleen's important immune functions.
Diagnostic Considerations
The presence of splenomegaly can be a significant predictor of certain tropical diseases, such as malaria, with a likelihood ratio (LR+) of 5.1 to 13.6, as indicated in a systematic review and meta-analysis 1. Other predictors for malaria include thrombocytopenia and hyperbilirubinemia. For dengue, returning from Asia and having a skin rash or leucopenia are significant predictors.
Prevention of Complications
Patients with splenomegaly should avoid contact sports and activities with high risk of abdominal trauma to prevent splenic rupture, which is a medical emergency requiring immediate attention. In cases of splenic abscess, as discussed in the context of infective endocarditis 1, management may involve antibiotics, percutaneous drainage, or splenectomy, depending on the severity and the patient's condition.
Key Recommendations
- Identify and treat the underlying cause of splenomegaly.
- Consider splenectomy or other interventions for severe cases with significant symptoms or complications.
- Avoid contact sports and high-risk activities to prevent splenic rupture.
- Use recent guidelines and evidence-based practices for management, such as those recommended for liver transplantation candidates 1 and patients with myeloproliferative neoplasms 1.
From the Research
Definition and Causes of Splenomegaly
- Splenomegaly refers to the enlargement of the spleen, which can be due to various mechanisms and 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.
- In tropical regions, malaria and schistosomiasis are common causes of splenomegaly, with as many as 80% of people having splenomegaly 2.
Diagnosis of Splenomegaly
- Physical examination can 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, except for apparent causes such as infectious mononucleosis 2.
- A logical approach to the patient with splenomegaly involves considering the aetiology of splenomegaly in the developed world and using a combination of clinical and radiologic data to narrow the differential diagnosis 3, 4.
Management and Complications of Splenomegaly
- Management of splenomegaly involves treating the underlying disease process 2.
- Splenectomies and spleen reduction therapies are sometimes performed, and any patient with limited splenic function requires increased vaccination and prophylactic antibiotics for procedures involving the respiratory tract 2.
- Acute infections, anemia, and splenic rupture are the most common complications of splenomegaly, and people with splenomegaly should refrain from participating in contact sports to decrease the risk of rupture 2.
- Splenectomy can be an effective diagnostic modality in determining a pathologic cause for splenomegaly, and laparoscopic splenectomy can be performed safely in appropriate cases 5.