Splenomegaly causes: Difference between revisions

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/* Causes in Alphabetical OrderSailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:77 ISBN 1591032016 Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachuset...
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__NOTOC__
__NOTOC__
{{Splenomegaly}}
{{Splenomegaly}}
{{CMG}}
{{CMG}}; {{AE}} {{VSKP}}


==Overview==
==Overview==
The causes of splenomegaly vary widely and range from increased splenic function (such as [[hemoglobinopathies]]), splenic congestion due to abnormal blood flow (such as venous obstruction), and splenic infiltration (such as storage disorders and [[malignancies]]).


==Causes==
==Causes==


===Common Causes===
*[[Bacterial endocarditis]]
*[[Infectious mononucleosis]]
*[[Cirrhosis]]
*[[Congestive heart failure]]
*[[Leukemia]]
*[[Alcohol abuse|Long standing alcohol abuse]]
*[[Lymphoma]]
*[[Malaria]]
*[[Portal hypertension ]]
*[[Sickle cell anemia]]
*[[Spherocytosis]]
*[[Thalassemia]]
===Less Common Causes <ref>Kahan, Scott, Smith, Ellen G. In a page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:157</ref>===
*[[Amyloidosis]]
*[[Babesiosis]]
*[[Gaucher's disease]]
*[[Histoplasmosis]]
*[[Kala-azar]]
[[Rickets]]
*[[Schistosomiasis]]
*[[Syphilis]]
*[[Toxoplasmosis]]
*[[Typhoid fever]]
===Causes by Pathogenesis===
===Causes by Pathogenesis===


{| class="wikitable"
{| class="wikitable"
|-
|-
! Increased function
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Mechanism
! Abnormal blood flow
! colspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" + |Pathogenesis
! Infiltration
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Example
|-
! rowspan="5" align="center" style="background:#4479BA; color: #FFFFFF;" + |Increased function
! colspan="2" |Removal of defective RBCs
| <div style="-moz-column-count:2; column-count:2;">
* [[Spherocytosis]]
* [[Thalassemia]]
* [[Hemoglobinopathy]]
* [[Anemia]]
* [[Sickle cell anemia]]
</div>
|-
! rowspan="3" |Immune hyperplasia
!Response to infection (viral, bacterial, fungal, parasitic)
| <div style="-moz-column-count:2; column-count:2;">
* [[Mononucleosis]]
* [[AIDS]]
* [[Viral hepatitis]]
* [[Endocarditis|Subacute bacterial endocarditis]]
* [[Sepsis|Bacterial septicemia]]
* [[Splenic abscess]]
* [[Typhoid fever]]
* [[Leptospirosis]]
* [[Tuberculosis]]
* [[Histoplasmosis]]
* [[Malaria]]
* [[leishmaniasis]]
* [[Trypanosomiasis]]
* [[Ehrlichiosis]]
</div>
|-
!Disordered immunoregulation
| <div style="-moz-column-count:2; column-count:2;">
* [[Rheumatoid arthritis]]
* [[SLE]]
* [[Serum sickness]]
* [[Autoimmune hemolytic anemia]]
* [[Idiopathic thrombocytopenic purpura|Immune thrombocytopenia]]
* [[Sarcoidosis]]
</div>
|-
!Drug reactions
|
* [[Cidofovir]]
* [[Filgrastim]]
|-
! colspan="2" |Extramedullary hematopoiesis
| <div style="-moz-column-count:2; column-count:2;">
* [[Myelofibrosis]]
* [[Tumors]]
* [[Marrow infiltration by tumors, leukemias|Lukemias]]
* [[marrow damage by radiation, toxins|Marrow damage by radiation]]
* [[marrow damage by radiation, toxins|toxins]]
</div>
|-
! rowspan="3" align="center" style="background:#4479BA; color: #FFFFFF;" + |Abnormal blood flow
! colspan="2" |Organ Failure
|
* [[Cirrhosis]]
* [[Congestive heart failure]]
|-
! colspan="2" |Vascular
| <div style="-moz-column-count:2; column-count:2;">
* [[Hepatic vein obstruction]]
* [[Portal vein thrombosis|Portal vein obstruction]]
* [[Budd-Chiari syndrome]]
* Splenic vein obstruction
</div>
|-
! colspan="2" |Infections
|
* Hepatic [[schistosomiasis]]
* Hepatic [[echinococcosis]]
|-
! rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" + |Infiltration
! colspan="2" |Metabolic diseases
| <div style="-moz-column-count:2; column-count:2;">
* [[Gauchers disease]]
* [[Niemann-Pick disease]]
* [[Hurler syndrome]]
* [[Mucopolysaccharidoses]]
* [[Amyloidosis]]
* [[Tangier disease]]
</div>
|-
|-
| valign = top | '''''Removal of defective RBCs'''''
! colspan="2" |Benign and malignant infiltrations
[[Spherocytosis]]<br />
| <div style="-moz-column-count:2; column-count:2;">
[[Thalassemia]]<br />
* [[Leukemias]] ([[acute]], [[chronic]], [[lymphoid]] and [[myeloid]])
[[Hemoglobinopathies]]<br />
* [[Lymphomas]] ([[Hodgkins]] and [[Non-Hodgkin lymphoma|non-hodgkins]])
Nutritional [[anemia]]s<br />
* [[Myeloproliferative]] disorders
early [[sickle cell anemia]]<br />
* [[Metastatic]] tumors (commonly [[melanoma]])
'''''Immune hyperplasia'''''<br />
* [[Histiocytosis X]]
''Response to infection (viral,bacterial,fungal,parasitic'')<br />[[Mononucleosis]], [[AIDS]], [[Viral hepatitis]]<br />Subacute [[bacterial endocarditis]], bacterial [[septicemia]]<br/> Splenic [[abscess]], [[Typhoid fever]]<br />[[brucellosis]],[[Leptospirosis]], [[tuberculosis]]<br />[[Histoplasmosis]]<br />[[Malaria]], [[leishmaniasis]], [[trypanosomiasis]]<br />[[Ehrlichiosis]]<br />''Disordered immunoregulation''<br />[[Rheumatoid arthritis]]<br />[[SLE]]<br />[[Serum sickness]]<br />[[Autoimmune hemolytic anemia]]<br />[[Idiopathic thrombocytopenic purpura|Immune thrombocytopenia]]<br />[[Sarcoidosis]]<br />Drug reactions<br />'''''Extramedullary hematopoiesis'''''<br />[[Myelofibrosis]]<br />Marrow infiltration by [[tumors]], [[leukemias]]<br />marrow damage by [[radiation]], [[toxins]]
* [[Hemangioma]]
| valign = top | '''''Organ Failure'''''<br />
* [[Lymphangioma]]
[[Cirrhosis]]<br />[[congestive heart failure]]<br />'''''Vascular'''''<br />[[Hepatic vein obstruction]]<br />[[Portal vein thrombosis|Portal vein obstruction]]<br />[[Budd-Chiari syndrome]]<br />[[Splenic vein obstruction]]<br />'''''Infections'''''<br />Hepatic [[schistosomiasis]]<br />Hepatic [[echinococcosis]]
* [[Splenic cyst]]
| valign = top | '''''Metabolic diseases'''''<br />[[Gauchers disease]]<br />[[Niemann-Pick disease]]<br />[[Hurler syndrome]] and other [[Mucopolysaccharidoses]]<br />[[Amyloidosis]]<br />[[Tangier disease]]<br />'''''Benign and malignant infiltrations'''''<br />[[Leukemias]](acute, chronic, lymphoid and myeloid)<br />Lymphomas ([[Hodgkins]] and [[Non-Hodgkin lymphoma|non-hodgkins]])<br />[[Myeloproliferative]] disorders<br />[[Metastatic]] tumors(commonly [[melanoma]])<br />[[Histiocytosis X]]<br />[[Hemangioma]],[[Lymphangioma]]<br />Splenic [[cysts]]<br />[[Hamartomas]]<br />[[Eosinophilic granuloma]]
* [[Hamartomas]]
 
* [[Eosinophilic granuloma]]
</div>
|}
|}


Line 40: Line 150:
*[[Myelofibrosis]]
*[[Myelofibrosis]]
*[[Polycythemia vera]]
*[[Polycythemia vera]]
*[[Portal hypertension]] of Bilharziasis
*[[Portal hypertension]] of [[Bilharziasis]]
*[[Sarcoidosis]]
*[[Sarcoidosis]]
*[[Thalassemia]]
*[[Thalassemia]]
===Common Causes===
===Less Common Causes <ref>Kahan, Scott, Smith, Ellen G. In a page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:157</ref>===
*[[Amyloidosis]]
*[[Babesiosis]]
*[[Gaucher's disease]]
*[[Histoplasmosis]]
*[[Kala-azar]]
*[[Rickets]]
*[[Schistosomiasis]]
*[[Syphilis]]
*[[Toxoplasmosis]]
*[[Typhoid fever]]


===Causes by Organ System===
===Causes by Organ System===


{|style="width:80%; height:100px" border="1"
{| style="width:80%; height:100px" border="1"
|style="height:100px"; style="width:25%" border="1" bgcolor="LightSteelBlue" |'''Cardiovascular'''
| style="width:25%" bgcolor="LightSteelBlue" ; border="1" |'''Cardiovascular'''
|style="height:100px"; style="width:75%" border="1" bgcolor="Beige" | [[Congestive heart failure]], [[Constrictive pericarditis]], [[Infective endocarditis]]  
| style="width:75%" bgcolor="Beige" ; border="1" | [[Congestive heart failure]], [[Constrictive pericarditis]], [[Infective endocarditis]]  
|-
|-
|bgcolor="LightSteelBlue"| '''Chemical/Poisoning'''
| bgcolor="LightSteelBlue" | '''Chemical/Poisoning'''
|bgcolor="Beige"| No underlying causes
| bgcolor="Beige" | No underlying causes
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Dental'''
| '''Dental'''
|bgcolor="Beige"| No underlying causes
| bgcolor="Beige" | No underlying causes
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Dermatologic'''
| '''Dermatologic'''
|bgcolor="Beige"| No underlying causes
| bgcolor="Beige" | No underlying causes
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Drug Side Effect'''
| '''Drug Side Effect'''
|bgcolor="Beige"| [[Cidofovir]], [[Filgrastim]]  
| bgcolor="Beige" | [[Cidofovir]], [[Filgrastim]]  
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Ear Nose Throat'''
| '''Ear Nose Throat'''
|bgcolor="Beige"| No underlying causes
| bgcolor="Beige" | No underlying causes
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Endocrine'''
| '''Endocrine'''
|bgcolor="Beige"|  [[Thyrotoxicosis]]  
| bgcolor="Beige" |  [[Thyrotoxicosis]]  
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Environmental'''
| '''Environmental'''
|bgcolor="Beige"| No underlying causes
| bgcolor="Beige" | No underlying causes
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Gastroenterologic'''
| '''Gastroenterologic'''
|bgcolor="Beige"| [[Cirrhosis]], [[Cruveilhier-Baumgarten syndrome]], [[Hepatic portal vein obstruction]], [[Hepatic vein thrombosis]], [[Portal hypertension]], [[Splenic vein thrombosis]]  
| bgcolor="Beige" | [[Cirrhosis]], [[Cruveilhier-Baumgarten syndrome]], [[Hepatic portal vein obstruction]], [[Hepatic vein thrombosis]], [[Portal hypertension]], [[Splenic vein thrombosis]]  
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Genetic'''
| '''Genetic'''
|bgcolor="Beige"| [[Aicardi Goutieres syndrome]], [[Alpha-mannosidase deficiency]], [[Apolipoprotein C-II deficiency]], [[Chanarin-Dorfman disease]], [[Chediak-Higashi disease]], [[Cholesterol ester storage disease]], [[Familial alphalipoprotein deficiency]], [[Familial histiocytic reticulosis]], [[Familial hypertriglyceridaemia]], [[Farber lipogranulomatosis]], [[Fucosidosis]], [[Fumarate hydratase deficiency]], [[Galactose epimerase deficiency]], [[Galactose-1-phosphate uridyltransferase deficiency]], [[Gamma heavy chain disease]], [[Gangliosidosis GM1, type 1]], [[Gangliosidosis GM1, type 3]], [[Gangliosidosis GM3]], [[Gaucher's disease]], [[Glucose phosphate isomerase deficiency]], [[Glycogen storage disease]], [[Haemochromatosis]], [[Hurler syndrome]], [[Hurler-Scheie syndrome]], [[Hyperlipidemia]], [[Iduronate-2-sulfatase deficiency]], [[Kartagener syndrome]], [[Langerhans cell histiocytosis ]], [[Lecithin cholesterol acyltransferase deficiency]], [[Long-chain 3-hydroxyacyl-coenzyme A dehydrogenase deficiency]], [[McLeod syndrome]], [[Mevalonate kinase deficiency]], [[Mu chain disease]], [[Mucolipidosis II alpha/beta]], [[Mucopolysaccharidosis VI]], [[Mucopolysaccharidosis VII]], [[Nakajo-Nishimura syndrome]], [[Niemann-Pick disease]], [[Prolidase deficiency]], [[Salla disease]], [[Sandhoff disease]], [[Sanfilippo disease]], [[Sea blue histiocytosis]], [[Sialidosis ]], [[Sphingomyelinase deficiency]], [[Tyrosinaemia type 1]], [[Zimmermann-Laband syndrome]]  
| bgcolor="Beige" | [[Aicardi Goutieres syndrome]], [[Alpha-mannosidase deficiency]], [[Apolipoprotein C-II deficiency]], [[Chanarin-Dorfman disease]], [[Chediak-Higashi disease]], [[Cholesterol ester storage disease]], [[Familial alphalipoprotein deficiency]], [[Familial histiocytic reticulosis]], [[Familial hypertriglyceridaemia]], [[Farber lipogranulomatosis]], [[Fucosidosis]], [[Fumarate hydratase deficiency]], [[Galactose epimerase deficiency]], [[Galactose-1-phosphate uridyltransferase deficiency]], [[Gamma heavy chain disease]], [[Gangliosidosis GM1, type 1]], [[Gangliosidosis GM1, type 3]], [[GM2 gangliosidosis]], [[Gaucher's disease]], [[Glucose phosphate isomerase deficiency]], [[Glycogen storage disease]], [[Haemochromatosis]], [[Hurler syndrome]], [[Hurler-Scheie syndrome]], [[Hyperlipidemia]], [[Iduronate-2-sulfatase deficiency]], [[Kartagener syndrome]], [[Langerhans cell histiocytosis ]] , [[Lecithin cholesterol acyltransferase deficiency]], [[Long-chain 3-hydroxyacyl-coenzyme A dehydrogenase deficiency]], [[McLeod syndrome]], [[Mevalonate kinase deficiency]], [[Mu chain disease]], [[Mucolipidosis II alpha/beta]], [[Mucopolysaccharidosis VI]], [[Mucopolysaccharidosis VII]], [[Nakajo-Nishimura syndrome]], [[Niemann-Pick disease]], [[Prolidase deficiency]], [[Salla disease]], [[Sandhoff disease]], [[Sanfilippo disease]], [[Sea blue histiocytosis]], [[Sialidosis ]] , [[Sphingomyelinase deficiency]], [[Tyrosinaemia type 1]], [[Zimmermann-Laband syndrome]]  
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Hematologic'''
| '''Hematologic'''
|bgcolor="Beige"|  [[Acute and chronic hemolytic anemias, all etiologies]], [[Autoimmune hemolytic anemia]], [[Congenital dyserythropoietic anaemia type 1]], [[Congenital erythropoeitic porphyria]], [[Coproporphyria, hereditary]], [[Eosinophillic granuloma]], [[Essential thrombocythemia]], [[Extramedullary haemopoiesis]], [[Haemoglobin C disease]], [[Haemoglobin E disease]], [[Haemoglobin SC disease]], [[Haemolytic disease of the newborn]], [[Hemolytic anemia]], [[Hemophagocytic lymphohistiocytosis]], [[Hereditary spherocytosis]], [[Histiocytosis X]], [[Hypereosinophilic syndrome]], [[Iron deficiency anemia]], [[Letterer-Siwe disease]], [[Mastocytosis]], [[Multiple myeloma]], [[Myelofibrosis]], [[Myeloid leukemia]], [[Myeloid metaplasia]], [[Myeloproliferative syndrome]], [[Osteomyelosclerosis]], [[Paroxysmal nocturnal hemoglobinuria]], [[Polycythemia vera]], [[Primary autoimmune haemolytic anaemia]], [[Primary thrombocythemia, acquired]], [[Rosai-Dorfman disease]], [[Sickle cell crisis]], [[Sickle cell disease]], [[Thalassemia major]], [[Waldenström's macroglobulinemia]]  
| bgcolor="Beige" |  [[Acute and chronic hemolytic anemias, all etiologies]], [[Autoimmune hemolytic anemia]], [[Congenital dyserythropoietic anaemia type 1]], [[Congenital erythropoeitic porphyria]], [[Coproporphyria, hereditary]], [[Granuloma| Eosinophillic granuloma]], [[Essential thrombocythemia]], [[Extramedullary haemopoiesis]], [[Haemoglobin C disease]], [[Haemoglobin E disease]], [[Haemoglobin SC disease]], [[Haemolytic disease of the newborn]], [[Hemolytic anemia]], [[Hemophagocytic lymphohistiocytosis]], [[Hereditary spherocytosis]], [[Histiocytosis X]], [[Hypereosinophilic syndrome]], [[Iron deficiency anemia]], [[Letterer-Siwe disease]], [[Mastocytosis]], [[Multiple myeloma]], [[Myelofibrosis]], [[Myeloid leukemia]], [[Myeloid metaplasia]], [[Myeloproliferative syndrome]], [[Osteomyelosclerosis]], [[Paroxysmal nocturnal hemoglobinuria]], [[Polycythemia vera]], [[Primary autoimmune haemolytic anaemia]], [[Primary thrombocythemia, acquired]], [[Rosai-Dorfman disease]], [[Sickle cell crisis]], [[Sickle cell disease]], [[Thalassemia major]], [[Waldenström's macroglobulinemia]]  
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Iatrogenic'''
| '''Iatrogenic'''
|bgcolor="Beige"|  No underlying causes
| bgcolor="Beige" |  No underlying causes
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Infectious Disease'''
| '''Infectious Disease'''
|bgcolor="Beige"|  [[Acanthocheilonemiasis]], [[AIDS]], [[Babesiosis]], [[Bartonellosis]], [[Borreliosis]], [[Cat-Scratch disease]], [[Coronavirus]], [[Corynebacterium diphtheriae]], [[Cytomegalovirus]], [[Dengue]], [[E.coli]], [[Ehrlichiosis]], [[Group B streptococcal infection]], [[Hepatic Echinococcosis]], [[Hepatitis]], [[Histoplasmosis]], [[Infectious mononucleosis]], [[Kala-Azar]], [[Leishmaniasis]], [[Leptospirosis]], [[Lyme disease]], [[Malaria]], [[Mycobacterium avium complex]], [[Paragonimiasis]], [[Psittacosis]], [[Q fever]], [[Relapsing fever]], [[Rickettsiae]], [[RMSF]], [[Rubella]], [[Salmonella]], [[Schistosomiasis]], [[Septicemia]], [[Sleeping sickness]], [[Splenic abscess]], [[Syphilis]], [[Toxocariasis]], [[Toxoplasma]], [[Trench fever]], [[Tropical splenomegaly syndrome]], [[Trypanosomiasis]], [[Tuberculosis]], [[Tularemia]], [[Visceral larva migrans]], [[Weil syndrome]], [[Whipple disease]]  
| bgcolor="Beige" |  [[Acanthocheilonemiasis]], [[AIDS]], [[Babesiosis]], [[Bartonellosis]], [[Borreliosis]], [[Cat-Scratch disease]], [[Coronavirus]], [[Corynebacterium diphtheriae]], [[Cytomegalovirus]], [[Dengue]], [[E.coli]], [[Ehrlichiosis]], [[Group B streptococcal infection]], [[Hepatic Echinococcosis]], [[Hepatitis]], [[Histoplasmosis]], [[Infectious mononucleosis]], [[Kala-Azar]], [[Leishmaniasis]], [[Leptospirosis]], [[Lyme disease]], [[Malaria]], [[Mycobacterium avium complex]], [[Paragonimiasis]], [[Psittacosis]], [[Q fever]], [[Relapsing fever]], [[Rickettsiae]], [[RMSF]], [[Rubella]], [[Salmonella]], [[Schistosomiasis]], [[Septicemia]], [[Sleeping sickness]], [[Splenic abscess]], [[Syphilis]], [[Toxocariasis]], [[Toxoplasma]], [[Trench fever]], [[Tropical splenomegaly syndrome]], [[Trypanosomiasis]], [[Tuberculosis]], [[Tularemia]], [[Visceral larva migrans]], [[Weil syndrome]], [[Whipple disease]]  


|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Musculoskeletal/Orthopedic'''
| '''Musculoskeletal/Orthopedic'''
|bgcolor="Beige"|  [[Osteopetrosis ]]
| bgcolor="Beige" |  [[Osteopetrosis ]]
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Neurologic'''
| '''Neurologic'''
|bgcolor="Beige"|  No underlying causes
| bgcolor="Beige" |  No underlying causes
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Nutritional/Metabolic'''
| '''Nutritional/Metabolic'''
|bgcolor="Beige"| [[Nutritional anemias]], [[Vitamin B12 deficiency]]  
| bgcolor="Beige" | [[Nutritional anemias]], [[Vitamin B12 deficiency]]  
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Obstetric/Gynecologic'''
| '''Obstetric/Gynecologic'''
|bgcolor="Beige"| No underlying causes
| bgcolor="Beige" | No underlying causes
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Oncologic'''
| '''Oncologic'''
|bgcolor="Beige"| [[Acute and chronic leukemias]], [[Adult T-cell leukemia]], [[Angioimmunoblastic lymphadenopathy with dysproteinaemia]], [[Angiosarcoma]], [[Autoimmune lymphoproliferative syndrome]], [[Bone marrow infiltration]], [[Castleman's disease]], [[Chronic eosinophilic leukaemia]], [[Chronic lymphocytic leukaemia]], [[Chronic myeloid leukaemia]], [[Fibromas]], [[Geleophysic dysplasia]], [[Hairy cell leukaemia]], [[Hamartomas]], [[Hepatosplenic T-cell lymphoma]],[[Hodgkin lymphoma]], [[Lymphangiomas]], [[Lymphoid leukemia]], [[Lympho-reticulosarcoma]], [[Mantle cell lymphoma]], [[Melanoma]], [[Metastatic solid tumors]], [[Monocytic leukemia]], [[Non-Hodgkin's lymphoma]], [[Primary splenic tumors]], [[Splenic hamartoma]], [[Splenic hemangioma]]  
| bgcolor="Beige" | [[Acute and chronic leukemias]], [[Adult T-cell leukemia]], [[Angioimmunoblastic lymphadenopathy with dysproteinaemia]], [[Angiosarcoma]], [[Autoimmune lymphoproliferative syndrome]], [[Bone marrow infiltration]], [[Castleman's disease]], [[Chronic eosinophilic leukaemia]], [[Chronic lymphocytic leukaemia]], [[Chronic myeloid leukaemia]], [[Fibroma]], [[Geleophysic dysplasia]], [[Hairy cell leukaemia]], [[Hamartomas]], [[Hepatosplenic T-cell lymphoma]],[[Hodgkin lymphoma]], [[Lymphangiomas]], [[Lymphoid leukemia]], [[Lympho-reticulosarcoma]], [[Mantle cell lymphoma]], [[Melanoma]], [[Metastatic solid tumors]], [[Monocytic leukemia]], [[Non-Hodgkin's lymphoma]], [[Primary splenic tumors]], [[Splenic hamartoma]], [[Splenic hemangioma]]  


|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Ophthalmologic'''
| '''Ophthalmologic'''
|bgcolor="Beige"| No underlying causes
| bgcolor="Beige" | No underlying causes
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Overdose/Toxicity'''
| '''Overdose/Toxicity'''
|bgcolor="Beige"| No underlying causes
| bgcolor="Beige" | No underlying causes
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Psychiatric'''
| '''Psychiatric'''
|bgcolor="Beige"| No underlying causes
| bgcolor="Beige" | No underlying causes
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Pulmonary'''
| '''Pulmonary'''
|bgcolor="Beige"| No underlying causes
| bgcolor="Beige" | No underlying causes
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Renal/Electrolyte'''
| '''Renal/Electrolyte'''
|bgcolor="Beige"| [[Nephrotic syndrome]],  
| bgcolor="Beige" | [[Nephrotic syndrome]],  
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Rheumatology/Immunology/Allergy'''
| '''Rheumatology/Immunology/Allergy'''
|bgcolor="Beige"| [[Amyloidosis]], [[Collagen vascular diseases]], [[Common variable hypogammaglobulinaemia]], [[Felty's syndrome]], [[Immune hemolytic anemias]], [[Juvenile chronic arthritis]], [[Macrophage activation syndrome]], [[Mixed essential cryoglobulinaemia]], [[Primary biliary cirrhosis]], [[Sarcoidosis]], [[Serum sickness]], [[Still disease, adult-onset]], [[Still disease, juvenile-onset]], [[Systemic lupus erythematosus]]  
| bgcolor="Beige" | [[Amyloidosis]], [[Collagen vascular diseases]], [[Common variable hypogammaglobulinaemia]], [[Felty's syndrome]], [[Immune hemolytic anemias]], [[Juvenile chronic arthritis]], [[Macrophage activation syndrome]], [[Mixed essential cryoglobulinaemia]], [[Primary biliary cirrhosis]], [[Sarcoidosis]], [[Serum sickness]], [[Still disease, adult-onset]], [[Still disease, juvenile-onset]], [[Systemic lupus erythematosus]]  
   
   
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Sexual'''
| '''Sexual'''
|bgcolor="Beige"| No underlying causes
| bgcolor="Beige" | No underlying causes
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Trauma'''
| '''Trauma'''
|bgcolor="Beige"| [[Trauma]]  
| bgcolor="Beige" | [[Trauma]]  


|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Urologic'''
| '''Urologic'''
|bgcolor="Beige"| No underlying causes
| bgcolor="Beige" | No underlying causes
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Miscellaneous'''
| '''Miscellaneous'''
|bgcolor="Beige"| [[Idiopathic splenomegaly]], [[Splenic artery anuerysm]], [[Splenic cysts]]   
| bgcolor="Beige" | [[Idiopathic splenomegaly]], [[Splenic artery aneurysm]], [[Splenic cyst]]   
|-
|-
|}
|}
Line 182: Line 275:
===Causes in Alphabetical Order<ref>Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:77 ISBN 1591032016</ref> <ref>Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:68 ISBN 140510368X</ref>===
===Causes in Alphabetical Order<ref>Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:77 ISBN 1591032016</ref> <ref>Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:68 ISBN 140510368X</ref>===


{{columns-list|3|
{{columns-list|
*[[Acanthocheilonemiasis]]
*[[Acute and chronic hemolytic anemias, all etiologies]]
*[[Acute and chronic leukemias]]
*[[Adult T-cell leukemia]]
*[[Aicardi Goutieres syndrome]]
*[[AIDS]]
*[[AIDS]]
*Angioimmunoblastic lymphoanedopathy
*[[Alpha-mannosidase deficiency]]
*[[Amyloidosis]]
*[[Angioimmunoblastic lymphadenopathy with dysproteinaemia]]
*[[Angiosarcoma]]
*[[Angiosarcoma]]
*[[Apolipoprotein C-II deficiency]]
*[[Autoimmune hemolytic anemia]]
*[[Autoimmune hemolytic anemia]]
*Bacterial septicemia
*[[Autoimmune lymphoproliferative syndrome ]]
*Bone marrow damage
*[[Babesiosis]]
*Bone marrow infiltration
*[[Bartonellosis]]
*[[Brucellosis]]
*[[Bone marrow infiltration]]
*Castleman's syndrome
*[[Borreliosis]]
*Cavernous transformation of the portal vein
*[[Castleman's disease]]
*[[Cellular infiltration]]
*[[Cat-scratch disease]]
*Chronic myoletic leukemia
*[[Chanarin-Dorfman disease]]
*[[Chediak-Higashi disease]]
*[[Cholesterol ester storage disease]]
*[[Chronic eosinophilic leukaemia]]
*[[Chronic lymphocytic leukaemia]]
*[[Chronic myeloid leukaemia]]
*[[Cidofovir]]
*[[Cidofovir]]
*[[Cirrhosis]]
*[[Collagen vascular diseases]]
*[[Collagen vascular diseases]]
*[[Common variable hypogammaglobulinaemia]]
*[[Congenital dyserythropoietic anaemia type 1]]
*[[Congenital erythropoeitic porphyria]]
*[[Congestive heart failure]]
*[[Congestive heart failure]]
*[[Constrictive pericarditis]]
*[[Constrictive pericarditis]]
*[[Coproporphyria, hereditary]]
*[[Coronavirus]]
*[[Coronavirus]]
*[[Corynebacterium diphtheriae]]
*[[Corynebacterium diphtheriae]]
*[[Cruveilhier-Baumgarten syndrome]]
*[[Cytomegalovirus]]
*[[Cytomegalovirus]]
*Early sickle cell anemia
*[[Dengue]]
*[[Endocarditis]]
*[[E.coli]]
*[[Ehrlichiosis]]
*[[Ehrlichiosis]]
*Eosinophillic granuloma
*[[Granuloma|Eosinophillic granuloma]]
*Epstein-Barr Virus Infection
*[[Essential thrombocythemia]]
*[[Extramedullary haemopoiesis]]
*[[Familial alphalipoprotein deficiency]]
*[[Familial histiocytic reticulosis]]
*[[Familial hypertriglyceridaemia]]
*[[Farber lipogranulomatosis]]
*[[Felty's syndrome]]
*[[Felty's syndrome]]
*Fever unknown origin
*[[Fibroma]]
*[[Fibroma]]s
*[[Filgrastim]]
*[[Fungal infections]]  
*[[Fucosidosis]]
*[[Fumarate hydratase deficiency]]
*[[Galactose epimerase deficiency]]
*[[Galactose-1-phosphate uridyltransferase deficiency]]
*[[Gamma heavy chain disease]]
*[[Gangliosidosis GM1, type 1]]
*[[Gangliosidosis GM1, type 3]]
*[[GM2 gangliosidosis]]
*[[Gaucher's disease]]
*[[Gaucher's disease]]
*[[Hemangioma]]s
*[[Geleophysic dysplasia]]
*[[Glucose phosphate isomerase deficiency]]
*[[Glycogen storage disease]]
*[[Group B streptococcal infection]]
*[[Haemochromatosis]]
*[[Haemoglobin C disease]]
*[[Haemoglobin E disease]]
*[[Haemoglobin SC disease]]
*[[Haemolytic disease of the newborn]]
*[[Hairy cell leukaemia]]
*[[Hamartomas]]
*[[Hamartomas]]
*[[Hemangiomas]]
*[[Hemoglobinopathy]]
*[[Hemoglobinopathy]]
*[[Hemolytic anemia]]
*[[Hemolytic anemia]]
*Hepatic [[echinococcosis]]
*[[Hemophagocytic lymphohistiocytosis]]
*Hepatic schistomasis
*[[Hepatic portal vein obstruction]]
*[[Hepatic vein obstruction]]
*[[Hepatic vein thrombosis]]
*[[Echinococcosis|Hepatic echinococcosis]]
*[[Hepatitis]]
*[[Hepatitis]]
*[[Hepatosplenic T-cell lymphoma]]
*[[Hereditary spherocytosis]]
*[[Hereditary spherocytosis]]
*[[Histiocytosis]]
*[[Histiocytosis X]]
*[[Histoplasmosis]]
*[[Histoplasmosis]]
*[[HIV]]
*[[Hodgkin lymphoma]]
*[[Hodgkin's lymphoma]]
*[[Hurler syndrome]]
*[[Hurler's syndrome]]
*[[Hurler-Scheie syndrome]]
*[[Hyperlipidemia]]s
*[[Hypereosinophilic syndrome]]
*Idiopathic splenomegaly
*[[Hyperlipidemia]]
*Immune hemolytic anemias
*[[Idiopathic splenomegaly]]
*[[Infective Endocarditis]]
*[[Iduronate-2-sulfatase deficiency]]
*[[Immune hemolytic anemias]]
*[[Infectious mononucleosis]]
*[[Infectious mononucleosis]]
*[[Interleukin-2]]
*[[Infective endocarditis]]
*[[Iron deficiency anemia]]
*[[Iron deficiency anemia]]
*[[Juvenile chronic arthritis]]
*[[Kala-azar]]
*[[Kartagener syndrome]]
*[[Langerhans cell histiocytosis ]]
*[[Lecithin cholesterol acyltransferase deficiency]]
*[[Leishmaniasis]]
*[[Leishmaniasis]]
*[[Leptospirosis]]
*[[Letterer-Siwe disease]]
*[[Letterer-Siwe disease]]
*[[Leukemia]]
*[[Long-chain 3-hydroxyacyl-coenzyme A dehydrogenase deficiency]]
*[[Lymphangioma]]s
*[[Lyme disease]]
*[[Lymphangiomas]]
*[[Lymphoid leukemia]]
*[[Lymphoid leukemia]]
*Lympho-reticulosarcoma
*[[Lympho-reticulosarcoma]]
*[[Macrophage activation syndrome]]
*[[Malaria]]
*[[Malaria]]
*[[Malignancy]]
*[[Mantle cell lymphoma]]
*[[Mastocytosis]]
*[[McLeod syndrome]]
*[[Melanoma]]
*[[Melanoma]]
*[[Metastatic solid tumors]]
*[[Mevalonate kinase deficiency]]
*[[Mixed essential cryoglobulinaemia]]
*[[Monocytic leukemia]]
*[[Mu chain disease]]
*[[Mucolipidosis II alpha/beta]]
*[[Mucopolysaccharidosis VI]]
*[[Mucopolysaccharidosis VII]]
*[[Multiple myeloma]]
*[[Myelofibrosis]]
*[[Myelofibrosis]]
*[[Myeloid leukemia]]
*[[Myeloid leukemia]]
*[[Myeloid metaplasia]]
*[[Myeloid metaplasia]]
*[[Monocytic leukemia]]
*[[Mycobacterium avium complex]]
*[[Mononucleosis]]
*[[Myeloproliferative syndrome]]
*Myobacterium avium complex
*[[Nakajo-Nishimura syndrome]]
*Myoproliferative syndrome(s)
*[[Niemann-Pick disease]]
*[[Niemann-Pick disease]]
*[[Non-Hodgkin's lymphoma]]
*[[Non-Hodgkin's lymphoma]]
*Nutritional anemias
*[[Nutritional anemias]]
*Osteomyelosclerosis
*[[Osteomyelosclerosis]]
*[[Osteopetrosis ]]
*[[Paragonimiasis]]
*[[Paroxysmal nocturnal hemoglobinuria]]
*[[Paroxysmal nocturnal hemoglobinuria]]
*[[Polycythemia vera]]
*[[Polycythemia vera]]
*[[Portal hypertension]]
*[[Portal hypertension]]
*[[Primary autoimmune haemolytic anaemia]]
*[[Primary biliary cirrhosis]]
*[[Primary splenic tumors]]
*[[Primary thrombocythemia, acquired]]
*[[Prolidase deficiency]]
*[[Psittacosis]]
*[[Q fever]]
*[[Q fever]]
*Radiation
*[[Radiation]]
*[[Rheumatoid arthritis]]
*[[Relapsing fever]]
*[[felty syndrome]]
*[[Rickettsiae]]
*[[RMSF]]
*[[RMSF]]
*[[Rosai-Dorfman disease]]
*[[Rubella]]
*[[Salla disease]]
*[[Salmonella]]
*[[Sandhoff disease]]
*[[Sanfilippo disease]]
*[[Sarcoidosis]]
*[[Sarcoidosis]]
*[[Schistosomiasis]]
*[[Schistosomiasis]]
*[[Sea blue histiocytosis]]
*[[Septicemia]]
*[[Serum sickness]]
*[[Serum sickness]]
*[[Sialidosis ]]
*[[Sickle cell crisis]]
*[[Sickle cell disease]]
*[[Sickle cell disease]]
*Splenic [[abscess]]
*[[Sleeping sickness]]
*Splenic artery anuerysm
*[[Sphingomyelinase deficiency]]
*[[Splenic cyst]]
*[[Splenic artery aneurysm]]
*[[Hamartoma | Splenic hamartoma]]  
*[[Splenic vein thrombosis]]
*Splenic [[hemangioma]]
*[[Splenic abscess]]
*Splenic vein obstruction/thrombosis
*[[Splenic cyst]]
*Stillness disease
*[[Splenic hamartoma]]
*[[Subacute bacterial endocarditis]]
*[[Splenic hemangioma]]
*[[Syphillis]]
*[[Still disease, adult-onset]]
*[[Still disease, juvenile-onset]]
*[[Syphilis]]
*[[Systemic lupus erythematosus]]
*[[Systemic lupus erythematosus]]
*[[Tangier disease]]
*[[Thalassemia major]]
*[[Thalassemia major]]
*[[Thyrotoxicosis]]
*[[Thyrotoxicosis]]
*[[Toxoplasmosis]]
*[[Toxocariasis]]
*[[Toxoplasma]]
*[[Trauma]]
*[[Trauma]]
*[[Trench fever]]
*[[Tropical splenomegaly syndrome]]
*[[Trypanosomiasis]]
*[[Trypanosomiasis]]
*[[Tuberculosis]]
*[[Tuberculosis]]
*[[Tumor]]s
*[[Tularemia]]
*[[Typhoid fever]]
*[[Tumors]]
*Vein obstruction
*[[Tyrosinaemia type 1]]
*[[Viral hepatitis]]
*[[Visceral larva migrans]]
*[[Weil's disease]]
*[[Vitamin B12 deficiency]]
*[[Waldenström's macroglobulinemia]]
*[[Weil syndrome]]
*[[Whipple disease]]
*[[Zimmermann-Laband syndrome]]
}}
}}


==References==
==References==
{{Reflist|2}}
{{Reflist|2}}
 
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[[Category:Hematology]]
[[Category:Hematology]]
[[Category:Gastroenterology]]
[[Category:Gastroenterology]]
[[Category:Primary care]]
{{WH}}
{{WS}}

Latest revision as of 00:14, 30 July 2020


Template:Splenomegaly Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Venkata Sivakrishna Kumar Pulivarthi M.B.B.S [2]

Overview

The causes of splenomegaly vary widely and range from increased splenic function (such as hemoglobinopathies), splenic congestion due to abnormal blood flow (such as venous obstruction), and splenic infiltration (such as storage disorders and malignancies).

Causes

Common Causes

Less Common Causes [1]

Rickets

Causes by Pathogenesis

Mechanism Pathogenesis Example
Increased function Removal of defective RBCs
Immune hyperplasia Response to infection (viral, bacterial, fungal, parasitic)
Disordered immunoregulation
Drug reactions
Extramedullary hematopoiesis
Abnormal blood flow Organ Failure
Vascular
Infections
Infiltration Metabolic diseases
Benign and malignant infiltrations

Causes of Massive Splenomegaly (>1000 gms)

Causes by Organ System

Cardiovascular Congestive heart failure, Constrictive pericarditis, Infective endocarditis
Chemical/Poisoning No underlying causes
Dental No underlying causes
Dermatologic No underlying causes
Drug Side Effect Cidofovir, Filgrastim
Ear Nose Throat No underlying causes
Endocrine Thyrotoxicosis
Environmental No underlying causes
Gastroenterologic Cirrhosis, Cruveilhier-Baumgarten syndrome, Hepatic portal vein obstruction, Hepatic vein thrombosis, Portal hypertension, Splenic vein thrombosis
Genetic Aicardi Goutieres syndrome, Alpha-mannosidase deficiency, Apolipoprotein C-II deficiency, Chanarin-Dorfman disease, Chediak-Higashi disease, Cholesterol ester storage disease, Familial alphalipoprotein deficiency, Familial histiocytic reticulosis, Familial hypertriglyceridaemia, Farber lipogranulomatosis, Fucosidosis, Fumarate hydratase deficiency, Galactose epimerase deficiency, Galactose-1-phosphate uridyltransferase deficiency, Gamma heavy chain disease, Gangliosidosis GM1, type 1, Gangliosidosis GM1, type 3, GM2 gangliosidosis, Gaucher's disease, Glucose phosphate isomerase deficiency, Glycogen storage disease, Haemochromatosis, Hurler syndrome, Hurler-Scheie syndrome, Hyperlipidemia, Iduronate-2-sulfatase deficiency, Kartagener syndrome, Langerhans cell histiocytosis  , Lecithin cholesterol acyltransferase deficiency, Long-chain 3-hydroxyacyl-coenzyme A dehydrogenase deficiency, McLeod syndrome, Mevalonate kinase deficiency, Mu chain disease, Mucolipidosis II alpha/beta, Mucopolysaccharidosis VI, Mucopolysaccharidosis VII, Nakajo-Nishimura syndrome, Niemann-Pick disease, Prolidase deficiency, Salla disease, Sandhoff disease, Sanfilippo disease, Sea blue histiocytosis, Sialidosis , Sphingomyelinase deficiency, Tyrosinaemia type 1, Zimmermann-Laband syndrome
Hematologic Acute and chronic hemolytic anemias, all etiologies, Autoimmune hemolytic anemia, Congenital dyserythropoietic anaemia type 1, Congenital erythropoeitic porphyria, Coproporphyria, hereditary, Eosinophillic granuloma, Essential thrombocythemia, Extramedullary haemopoiesis, Haemoglobin C disease, Haemoglobin E disease, Haemoglobin SC disease, Haemolytic disease of the newborn, Hemolytic anemia, Hemophagocytic lymphohistiocytosis, Hereditary spherocytosis, Histiocytosis X, Hypereosinophilic syndrome, Iron deficiency anemia, Letterer-Siwe disease, Mastocytosis, Multiple myeloma, Myelofibrosis, Myeloid leukemia, Myeloid metaplasia, Myeloproliferative syndrome, Osteomyelosclerosis, Paroxysmal nocturnal hemoglobinuria, Polycythemia vera, Primary autoimmune haemolytic anaemia, Primary thrombocythemia, acquired, Rosai-Dorfman disease, Sickle cell crisis, Sickle cell disease, Thalassemia major, Waldenström's macroglobulinemia
Iatrogenic No underlying causes
Infectious Disease Acanthocheilonemiasis, AIDS, Babesiosis, Bartonellosis, Borreliosis, Cat-Scratch disease, Coronavirus, Corynebacterium diphtheriae, Cytomegalovirus, Dengue, E.coli, Ehrlichiosis, Group B streptococcal infection, Hepatic Echinococcosis, Hepatitis, Histoplasmosis, Infectious mononucleosis, Kala-Azar, Leishmaniasis, Leptospirosis, Lyme disease, Malaria, Mycobacterium avium complex, Paragonimiasis, Psittacosis, Q fever, Relapsing fever, Rickettsiae, RMSF, Rubella, Salmonella, Schistosomiasis, Septicemia, Sleeping sickness, Splenic abscess, Syphilis, Toxocariasis, Toxoplasma, Trench fever, Tropical splenomegaly syndrome, Trypanosomiasis, Tuberculosis, Tularemia, Visceral larva migrans, Weil syndrome, Whipple disease
Musculoskeletal/Orthopedic Osteopetrosis
Neurologic No underlying causes
Nutritional/Metabolic Nutritional anemias, Vitamin B12 deficiency
Obstetric/Gynecologic No underlying causes
Oncologic Acute and chronic leukemias, Adult T-cell leukemia, Angioimmunoblastic lymphadenopathy with dysproteinaemia, Angiosarcoma, Autoimmune lymphoproliferative syndrome, Bone marrow infiltration, Castleman's disease, Chronic eosinophilic leukaemia, Chronic lymphocytic leukaemia, Chronic myeloid leukaemia, Fibroma, Geleophysic dysplasia, Hairy cell leukaemia, Hamartomas, Hepatosplenic T-cell lymphoma,Hodgkin lymphoma, Lymphangiomas, Lymphoid leukemia, Lympho-reticulosarcoma, Mantle cell lymphoma, Melanoma, Metastatic solid tumors, Monocytic leukemia, Non-Hodgkin's lymphoma, Primary splenic tumors, Splenic hamartoma, Splenic hemangioma
Ophthalmologic No underlying causes
Overdose/Toxicity No underlying causes
Psychiatric No underlying causes
Pulmonary No underlying causes
Renal/Electrolyte Nephrotic syndrome,
Rheumatology/Immunology/Allergy Amyloidosis, Collagen vascular diseases, Common variable hypogammaglobulinaemia, Felty's syndrome, Immune hemolytic anemias, Juvenile chronic arthritis, Macrophage activation syndrome, Mixed essential cryoglobulinaemia, Primary biliary cirrhosis, Sarcoidosis, Serum sickness, Still disease, adult-onset, Still disease, juvenile-onset, Systemic lupus erythematosus
Sexual No underlying causes
Trauma Trauma
Urologic No underlying causes
Miscellaneous Idiopathic splenomegaly, Splenic artery aneurysm, Splenic cyst

Causes in Alphabetical Order[2] [3]

References

  1. ↑ Kahan, Scott, Smith, Ellen G. In a page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:157
  2. ↑ Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:77 ISBN 1591032016
  3. ↑ Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:68 ISBN 140510368X

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