Splenomegaly Explained

Splenomegaly
Field:General surgery

Splenomegaly is an enlargement of the spleen. The spleen usually lies in the left upper quadrant (LUQ) of the human abdomen. Splenomegaly is one of the four cardinal signs of hypersplenism which include: some reduction in number of circulating blood cells affecting granulocytes, erythrocytes or platelets in any combination; a compensatory proliferative response in the bone marrow; and the potential for correction of these abnormalities by splenectomy. Splenomegaly is usually associated with increased workload (such as in hemolytic anemias), which suggests that it is a response to hyperfunction. It is therefore not surprising that splenomegaly is associated with any disease process that involves abnormal red blood cells being destroyed in the spleen. Other common causes include congestion due to portal hypertension and infiltration by leukemias and lymphomas. Thus, the finding of an enlarged spleen, along with caput medusae, is an important sign of portal hypertension.[1]

Definition

The standard system for classifying splenomegaly on radiography is:[2] [3]

Also, a cutoff of a craniocaudal height of 13 cm is also used to define splenomegaly.[4] In addition, individual intervals have been established:

90% confidence interval of maximum spleen length by abdominal ultrasonography by height of the person[5]
Height Spleen length
Women Men
155 – 159 cm 6.4 – 12 cm
160 – 164 cm 7.4 - 12.2 cm 8.9 - 11.3 cm
165 – 169 cm 7.5 – 11.9 cm 8.5 – 12.5 cm
170 – 174 cm 8.3 – 13.0 cm 8.6 – 13.1 cm
175 – 179 cm 8.1 – 12.3 cm 8.6 – 13.4 cm
180 – 184 cm 9.3 – 13.4 cm
185 – 189 cm 9.3 – 13.6 cm
190 – 194 cm 9.7 – 14.3 cm
195 – 199 cm 10.2 – 14.4 cm
Age Cutoff[6]
3 months 6.0 cm
6 months 6.5 cm
12 months 7.0 cm
2 years 8.0 cm
4 years 9.0
6 years 9.5 cm
8 years 10.0 cm
10 years 11.0 cm
12 years 11.5 cm
15 years
  • 12.0 cm
    for girls
  • 13.0 cm
    for boys
For children, the cutoffs for splenomegaly are given in this table, when measuring the greatest length of the spleen between its dome and its tip, in the coronal plane through its hilum while breathing quietly.[6]

At autopsy, splenomegaly can be defined as a spleen weight above the upper limit of the standard reference range of 230g.[7] [8]

Splenomegaly refers strictly to spleen enlargement, and is distinct from hypersplenism, which connotes overactive function by a spleen of any size. Splenomegaly and hypersplenism should not be confused. Each may be found separately, or they may coexist. Clinically, if a spleen is palpable (felt via external examination), it means it is enlarged as it has to undergo at least twofold enlargement to become palpable. However, the tip of the spleen may be palpable in a newborn baby up to three months of age.[9]

Calculators have been developed for measurements of spleen size based on CT, US, and MRI findings.[10]

Signs and symptoms

Symptoms may include abdominal pain, chest pain, chest pain similar to pleuritic pain when stomach, bladder or bowels are full, back pain, early satiety due to splenic encroachment, or the symptoms of anemia due to accompanying cytopenia.

Signs of splenomegaly may include a palpable left upper quadrant abdominal mass or splenic rub. It can be detected on physical examination by using Castell's sign, Traube's space percussion or Nixon's sign, but an ultrasound can be used to confirm diagnosis. In patients where the likelihood of splenomegaly is high, the physical exam is not sufficiently sensitive to detect it; abdominal imaging is indicated in such patients.[11]

In cases of infectious mononucleosis splenomegaly is a common symptom and health care providers may consider using abdominal ultrasonography to get insight into a person's condition.[12] However, because spleen size varies greatly, ultrasonography is not a valid technique for assessing spleen enlargement and should not be used in typical circumstances or to make routine decisions about fitness for playing sports.[12]

Causes

The most common causes of splenomegaly in developed countries are infectious mononucleosis, splenic infiltration with cancer cells from a hematological malignancy and portal hypertension (most commonly secondary to liver disease, and sarcoidosis). Splenomegaly may also come from bacterial infections, such as syphilis or an infection of the heart's inner lining (endocarditis).[13] Splenomegaly also occurs in mammals parasitized by Cuterebra fontinella.[14]

The possible causes of moderate splenomegaly (spleen <1000 g) are many, and include:

The causes of massive splenomegaly (spleen >1000 g) are

Pathophysiology

Splenomegaly can be classified based on its pathophysiologic mechanism:

Diagnosis

Abdominal CT is the most accurate. The spleen needs to be 2–3 times larger than normal to be palpable below the costal margin in physical examination.

Treatment

If the splenomegaly underlies hypersplenism, a splenectomy is indicated and will correct the hypersplenism. However, the underlying cause of the hypersplenism will most likely remain; consequently, a thorough diagnostic workup is still indicated, as, leukemia, lymphoma and other serious disorders can cause hypersplenism and splenomegaly. After splenectomy, however, patients have an increased risk for infectious diseases.

Patients undergoing splenectomy should be vaccinated against Haemophilus influenzae, Streptococcus pneumoniae, and Meningococcus. They should also receive annual influenza vaccinations. Long-term prophylactic antibiotics may be given in certain cases.

As an adaptation

An enlarged spleen may be an inherited, adaptive trait selected in populations that need extra oxygen carry capacity such as deep sea divers.[21] [22]

See also

References

  1. Ghazi. Ali. Hypercalcemia and huge splenomegaly presenting in an elderly patient with B-cell non-Hodgkin's lymphoma: a case report. Journal of Medical Case Reports. 2010. 4. 334. 330. 10.1186/1752-1947-4-330. 20959010. 2974746 . free .
  2. Web site: Splenomegaly. Neetu Radhakrishnan. Medscape. February 16, 2018. Updated Apr. 2012 (referring the classification system to Poulin et al.
  3. https://books.google.com/books?id=DdBJ6jCf8KgC&pg=PA1964 Page 1964
  4. Saboo. S S. Krajewski. K M. O'Regan. K N. Giardino. A. Brown. J R. Ramaiya. N. Jagannathan. J P. Spleen in haematological malignancies: spectrum of imaging findings. The British Journal of Radiology. 85. 1009. 2012. 81–92. 0007-1285. 10.1259/bjr/31542964. 22096219. 3473934.
  5. Chow. Kai Uwe. Luxembourg. Beate. Seifried. Erhard. Bonig. Halvard. Spleen Size Is Significantly Influenced by Body Height and Sex: Establishment of Normal Values for Spleen Size at US with a Cohort of 1200 Healthy Individuals. Radiology. 279. 1. 2016. 306–313. 0033-8419. 10.1148/radiol.2015150887. 26509293.
  6. Rosenberg. H K. Markowitz. R I. Kolberg. H. Park. C. Hubbard. A. Bellah. R D. Normal splenic size in infants and children: sonographic measurements. American Journal of Roentgenology. 157. 1. 1991. 119–121. 0361-803X. 10.2214/ajr.157.1.2048509. 2048509.
  7. Molina. D. Kimberley. DiMaio. Vincent J.M.. Normal Organ Weights in Men. The American Journal of Forensic Medicine and Pathology. 33. 4. 2012. 368–372. 0195-7910. 10.1097/PAF.0b013e31823d29ad. 22182984. 32174574.
  8. Molina. D. Kimberley. DiMaio. Vincent J. M.. Normal Organ Weights in Women. The American Journal of Forensic Medicine and Pathology. 36. 3. 2015. 182–187. 0195-7910. 10.1097/PAF.0000000000000175. 26108038. 25319215.
  9. 6107197. 2018. Pelizzo. G.. Spleen size evaluation in children: Time to define splenomegaly for pediatric surgeons and pediatricians. PLOS ONE. 13. 8. e0202741. Guazzotti. M.. Klersy. C.. Nakib. G.. Costanzo. F.. Andreatta. E.. Bassotti. G.. Calcaterra. V.. 30138410. 10.1371/journal.pone.0202741. 2018PLoSO..1302741P. free.
  10. Web site: Splenic Index & Volume Calculator (CT/MRI/US)+ Expected Normal . 2024-07-15 . Rad At Hand . en-US.
  11. Grover SA, Barkun AN, Sackett DL . The rational clinical examination. Does this patient have splenomegaly? . JAMA . 270 . 18 . 2218–21 . 1993 . 8411607 . 10.1001/jama.270.18.2218. Ovid full text
  12. , which cites
    • Putukian. M. O'Connor. FG. Stricker. P. McGrew. C. Hosey. RG. Gordon. SM. Kinderknecht. J. Kriss. V. Landry. G. Mononucleosis and athletic participation: an evidence-based subject review. Clinical Journal of Sport Medicine. Jul 2008. 18. 4. 309–15. 18614881. 10.1097/jsm.0b013e31817e34f8. 23780443.
    • Spielmann. AL. DeLong. DM. Kliewer. MA. Sonographic evaluation of spleen size in tall healthy athletes.. AJR. American Journal of Roentgenology. Jan 2005. 184. 1. 45–9. 15615949. 10.2214/ajr.184.1.01840045.
  13. Book: Kaiser, Larry R. . Pavan Atluri . Giorgos C Karakousis . Paige M Porrett . The surgical review: an integrated basic and clinical science study guide . Lippincott Williams & Wilkins . Hagerstwon, MD . 2006 . 0-7817-5641-3 .
  14. Durden LA. Bot Fly (Cuterebra fontinella fontinella) Parasitism of Cotton Mice (Peromyscus gossypinus) on St. Catherines Island, Georgia. The Journal of Parasitology. 81. 5. 787–790. 1995. 10.2307/3283977. 3283977. 7472877.
  15. Sproat . LO. . Pantanowitz . L. . Lu . CM. . Dezube . BJ. . Human immunodeficiency virus-associated hemophagocytosis with iron-deficiency anemia and massive splenomegaly . Clin Infect Dis . 37 . 11 . e170–3 . Dec 2003 . 10.1086/379613 . 14614691 . free .
  16. Friedman . AD. . Daniel . GK. . Qureshi . WA. . Systemic ehrlichiosis presenting as progressive hepatosplenomegaly . South Med J . 90 . 6 . 656–60 . Jun 1997 . 10.1097/00007611-199706000-00017. 9191748 .
  17. Book: The mucopolysaccharidoses . Neufeld EF, Muenzer J . The metabolic and molecular bases of inherited disease.7th ed. Vol. 2. . Scriver CR, Beaudet AL, Sly WS, Valle D . 1995 . McGraw-Hill, New York . 2465–94 .
  18. Suvajdzić . N. . Cemerikić-Martinović . V. . Saranović . D. . Petrović . M. . Popović . M. . Artiko . V. . Cupić . M. . Elezović . I. . Littoral-cell angioma as a rare cause of splenomegaly . Clinical and Laboratory Haematology . 28 . 5 . 317–20 . Oct 2006 . 10.1111/j.1365-2257.2006.00801.x . 16999722 .
  19. Dascalescu . CM. . Wendum . D. . Gorin . NC. . Littoral-cell angioma as a cause of splenomegaly . N Engl J Med . 345 . 10 . 772–3 . Sep 2001 . 10.1056/NEJM200109063451016 . 11547761 . free .
  20. Ziske . C. . Meybehm . M. . Sauerbruch . T. . Schmidt-Wolf . IG. . Littoral cell angioma as a rare cause of splenomegaly . Ann Hematol . 80 . 1 . 45–8 . Jan 2001 . 10.1007/s002770000223. 11233776 . 29326931 .
  21. News: Rappaport. Lisa. Large spleen helps explain deep-diving skills of Southeast Asian 'sea nomads'. 20 April 2018. Reuters. 19 April 2018.
  22. Ilardo. M. A.. Moltke. I.. Korneliussen. T. S.. Cheng. J.. Stern. A. J.. Racimo. F.. de Barros Damgaard. P.. Sikora. M.. Seguin-Orlando. A.. Rasmussen. S.. van den Munckhof. I. C. L.. ter Horst. R.. Joosten. L. A. B.. Netea. M. G.. Salingkat. S.. Nielsen. R.. Willerslev. E.. Physiological and Genetic Adaptations to Diving in Sea Nomads. Cell. 173. 3. 2018-04-18. 569–580.e15. 10.1016/j.cell.2018.03.054. 29677510. free.

External links

This article is licensed under the GNU Free Documentation License. It uses material from the Wikipedia article "Splenomegaly".

Except where otherwise indicated, Everything.Explained.Today is © Copyright 2009-2024, A B Cryer, All Rights Reserved. Cookie policy.