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Revision as of 00:02, 30 September 2018

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: ; Gichoya Judy Wawira [2], Moi University School of Medicine

Synonyms and keywords: Spleen enlargement; enlarged spleen; spleen swelling

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Splenomegaly from Other Diseases

Category	Disease		Etiology	Clinical manifestations												Para−clinical findings										Gold standard	Associated findings
				Demography	History	Symptoms					Signs					Lab Findings									Imaging
						Fever	Fatigue	Weight	Abdominal pain	Bleeding	BP	JVP	Jaundice	Ascites	Other	CBC			Iron	LFT	PT/PTT	BUN/Cr	UA	Histopathology
						Fever	Fatigue	Weight	Abdominal pain	Bleeding	BP	JVP	Jaundice	Ascites	Other	WBC	Hb	Plt	Iron	LFT	PT/PTT	BUN/Cr	UA	Histopathology
Congestive	Cirrhosis^[1]		Infection Alcohol Autoimmune	Any, more in elderly	Hepatitis Alcohol use NAFLD	–	+	↑↓	+	+	↓	Nl	+	+	Spider angiomata Palmar erythema Weakness	↓	↓	↓	Nl	↑	↑	↑	Dark urine	Pancytopenia Regenerating nodules of hepatocytes Fibrosis Deposition of connective tissue between these nodules	Small and nodular liver on ultrasound Fibrosis on liver scan	Liver biopsy	Hepatic encephalopathy Gynecomastia Hypogonadism Esophageal varices Caput medusa Dupuytren's contracture
	Heart failure^[2]		Coronary artery disease HTN	Elderly	Smoking Sedentary lifestyle Obstructive sleep apnea	–	+	↑↓	–	–	↑	↑	±	+	Dyspnea Weakness Chest pain Heart murmur	↓	↓	↑	Nl	↑	↑	↑	Nl	NA	Normal or low ejection fraction on echocardiography Cardiomegaly on chest x-ray	Echocardiography	Pulmonary edema Hyponatremia Elevated BNP
	Thrombosis of portal, hepatic, or splenic veins^[3]		Thrombosis	Any	Inflammation Infection Cirrhosis Cancer	+	+	↑	+	+	↓	Nl	±	+	Weakness Hematemesis Melena	↓	↓	↓	Nl	↑	↑	↑	Dark urine	NA	Reduced or absent blood flow on doppler ultrasonography	Doppler ultrasonography	Portal hypertension Esophageal varices
Malignancy	Lymphoma^[4]		Unknown Mutation Infection	Any, most common malignant splenic tumor	Epstein Barr virus Positive family history Smoking HIV Autoimmune diseases	+	+	↓	+	+	Nl	Nl	+	–	Lymphadenopathy Itching Night sweats Anorexia Dyspnea	↓	↓	↓	High ferritin	↑	↑	↑	Nl	Different histopathological features based on types and stages Reed-Sternberg cell Malignant cells	Peritoneal lymphomatosis on CT scan	Lymph node biopsy	Primary immune disorder Post-transplant
	Leukemia^[5]		Unknown Mutation Bone marrowinfiltration Ineffective hematopoiesis Immune mediated	Elderly, male>female	History of hematological disorder History of chemotherapy andionizing radiation	+	+	↓	+	+	Nl	Nl	±	+	Pallor Leukemia cutis Bruising Petechiae Ecchymosis Fatigue Bone tenderness Early satiety	↓	↓	↓	High ferritin	↑	↑	↑	Nl	Leukemic blasts Leukoerythroblastic features Giant platelets	NA	Bone marrow examination + clinical manifestation	Infections of variable severity Cranial nerve palsy
	Polycythemia Vera^[6]		Autonomous erythrocyteproduction JAK2mutation	Mean age >60 years old	Positive family history	–	+	Nl	+	–	Nl	Nl	–	–	Erythromelalgia Chest pain Stroke-like symptoms Pruritus Dizziness Visual disturbance Facial plethora Painful erythema Lymphadenopathy	Nl to ↑	↑	Nl to ↑	High ferritin	Nl	Nl	Nl	Nl	Elevated normochromic, normocytic RBCs Thrombocytosis Rarely immature cells Leukoerythroblastic picture	NA	WHO criteria for PV	Stroke Venous thrombosis Myelofibrosis Acute leukemia
	Disease		Etiology	Demography	History	Fever	Fatigue	Weight loss	Abdominal pain	Bleeding	BP	JVP	Jaundice	Ascites	Other	WBC	Hb	Plt	Iron	LFT	PT/PTT	BUN/Cr	UA	Histopathology	Imaging	Gold standard	Associated findings
	Multiple myeloma^[7]		Unknown Mutation Infection	Any, more in adults	Exposure to chemicals Radiation Pre-existent blood disorders	+	+	↓	+	+	Nl	Nl	+	–	Lymphadenopathy Itching Night sweats Anorexia Dyspnea	↓	↓	↓	High ferritin	Nl	↑	↑	Hemoglobinuria	Blast cells		Bone marrow examination	Tumor lysis syndrome Infection CNS involvement DIC
	Essential thrombocythemia^[8]		Acquired mutation of JAK2, CALR, or MPL	Mean age >60 years old, female > male	Vascular occlusive events and hemorrhages	±	+	Nl	+	+	Nl	Nl	–	–	Flushing Erythromelalgia Transient ischemic attacks Priapism Decreased visual acuity	↑	↑	↑↑	Nl	Nl	Nl	Nl	Nl	Increased cellularity Hyperplasia and clustering of megakaryocytes Bone marrow reticulin may be increased with no collagen fibrosis	Splenomegaly on abdominal CT VTE on spiral chest CT DVT on ultrasound	Bone marrow biopsy	Thrombosis
	Primary myelofibrosis^[9]		Bone marrow fibrosis Mutation in JAK2, CALR, or MPL	Mean age >60 years old, male> female	Other myeloproliferativedisorders Radiation exposure Chemicals exposure	–	+	Nl	+	+	Nl	Nl	+	–	Pallor Bruising Skin nodules Insert paragraph Fatigue Abdominal pain Early satiety Dyspnea Lymphadenopathy	↓	↓	↑/↓	Low iron	Nl	↑	Nl	Dark urine	Proliferation and atypia of megakaryocytes Reticulin or collagen fibrosis Hypercellular bone marrow	Diffuse bone sclerosis on CT	Bone marrow biopsy	Thrombosis Variable risk for development of acute leukemia
	Primary splenic tumors^[10]			Rare
	Metastatic solid tumors^[11]		Bone marrowinfiltration Ineffective hematopoiesis Immune mediated	Any, more in adults	Exposure to chemicals Radiation Pre-existent blood disorders	+	+	↓	+	+	↓	Nl	±	±	Petechiae Weakness	↓	↓	↓	Low iron, high ferritin	↑	↑	↑	Dark urine	Blast cells		Biopsy	Tumor lysis syndrome Infection CNS involvement DIC
	Disease		Etiology	Demography	History	Fever	Fatigue	Weight	Abdominal pain	Bleeding	BP	JVP	Jaundice	Ascites	Other	WBC	Hb	Plt	Iron	LFT	PT/PTT	BUN/Cr	UA	Histopathology	Imaging	Gold standard	Associated findings
Infection	Viral	Hepatitis^[12]	Infection Autoimmune	Any	High risk behaviors Close contact	+	+	↓	+	+	Nl	Nl	+	+	Lymphadenopathy Muscle weakness Joint swelling Focal neurologic signs Depends on etiology	↓	↓	↓	Nl	↑	↑	↑	Dark urine Hematuria	Pancytopenia		Clinical manifestation + lab tests	Depends on etiology Encephalomyelitis
		Infectious mononucleosis^[13]	EBV
		Cytomegalovirus^[14]
	Bacterial	Salmonella^[15]
		Brucella^[16]
		Tuberculosis^[17]
	Parasitic	Malaria^[18]
		Schistosomiasis^[19]
		Toxoplasmosis^[20]
		Kala-azar^[21]	Visceral leishmaniasis
	Infective endocarditis^[22]
	Fungal^[23]
	Disease		Etiology	Demography	History	Fever	Fatigue	Weight loss	Abdominal pain	Bleeding	BP	JVP	Jaundice	Ascites	Other	WBC	Hb	Plt	Iron	LFT	PT/PTT	BUN/Cr	UA	Histopathology	Imaging	Gold standard	Associated findings
Inflammation	Sarcoidosis		Immune mediated Unknown	Autoimmune disease, more in young African American women	Positive family history	+	+	↓	+	+	Nl	Nl	-	-	Bilateral hilar adenopathy Blurry vision Shortness of breath Cough Erythema nodosum	↑	↓	↑	Nl	Nl	Nl	Nl	Nl	NA	Bilateral hilar adenopathy on chest x-ray	Diagnosis of exclusion	Interstitial lung disease Systemic inflammatorydisease
	Serum sickness
	Systemic lupus erythematosus		Immune mediated bone marrow failure	More in young females	Family history	+	+	↓	+	+	Nl to ↓	Nl	+	+	Skin rash Mouth ulcers Chest pain Lymphadenopathy	↓	↓	↓		↑	↑	↑	Hemoglobinuria Proteinuria	Hypocellular bone marrow		Clinical findings + laboratory studies	Multi organ damage
	Felty syndrome		Immune mediated bone marrow failure	Rare autoimmune disease, more in females 50-70 years old	History of rheumatoid arthritis	+	+	↓	+	+	Nl to ↓	Nl	+	+	Pallor Skin hyperpigmentation Painful, stiff, and swollen joints Keratoconjunctivitis sicca	↓	↓	↓	Nl	Nl	Nl	Nl	Nl	Hypocellular bone marrow		Clinical findings + laboratory studies	Rheumatoid arthritis Infections
Infiltrative	Disease		Etiology	Demography	History	Fever	Fatigue	Weight loss	Abdominal pain	Bleeding	BP	JVP	Jaundice	Ascites	Other	WBC	Hb	Plt	Iron	LFT	PT/PTT	BUN/Cr	UA	Histopathology	Imaging	Gold standard	Associated findings
	Gaucher disease^[24]		Bone marrowinfiltration	Rare, mostly in children	Family history	-	+	↓	+	+	Nl to ↓	Nl	+	+		↓	↓	↓	Nl	Nl	↑	↑		Hypocellular bone marrow		Clinical findings + laboratory studies
	Niemann-Pick disease
	Amyloidosis
	Langerhans cell histiocytosis
	Hemophagocytic lymphohistiocytosis
	Rosai-Dorfman disease
Hematologic (hypersplenic) states	Hemolytic anemia
	Sickle cell disease
	Granulocyte colony-stimulating factor
	Disease		Etiology	Demography	History	Fever	Fatigue	Weight loss	Abdominal pain	Bleeding	BP	JVP	Jaundice	Ascites	Other	WBC	Hb	Plt	Iron	LFT	PT/PTT	BUN/Cr	UA	Histopathology	Imaging	Gold standard	Associated findings

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications, and Prognosis

Diagnosis

Treatment

Case Studies

Case #1

Related Chapters

References

↑ Wu Z, Zhou J, Pankaj P, Peng B (December 2012). "Laparoscopic and open splenectomy for splenomegaly secondary to liver cirrhosis: an evaluation of immunity". Surg Endosc. 26 (12): 3557–64. doi:10.1007/s00464-012-2366-5. PMID 22710653.
↑ Gedela M, Khan M, Jonsson O (September 2015). "Heart Failure". S D Med. 68 (9): 403–5, 407–9. PMID 26489162.
↑ Ferri PM, Ferreira AR, Fagundes ED, Liu SM, Roquete ML, Penna FJ (2012). "Portal vein thrombosis in children and adolescents: 20 years experience of a pediatric hepatology reference center". Arq Gastroenterol. 49 (1): 69–76. PMID 22481689.
↑ Ishibashi N, Maebayashi T, Aizawa T, Sakaguchi M, Abe O, Saito T, Tanaka Y (May 2015). "Myelosuppression toxicity of palliative splenic irradiation in myelofibrosis and malignant lymphoma". Hematology. 20 (4): 203–7. doi:10.1179/1607845414Y.0000000192. PMID 25131182.
↑ Quest GR, Johnston JB (December 2015). "Clinical features and diagnosis of hairy cell leukemia". Best Pract Res Clin Haematol. 28 (4): 180–92. doi:10.1016/j.beha.2015.10.017. PMID 26614896.
↑ Chou YS, Gau JP, Yu YB, Pai JT, Hsiao LT, Liu JH, Hong YC, Liu CY, Yang CF, Chen PM, Chiou TJ, Tzeng CH (March 2013). "Leukocytosis in polycythemia vera and splenomegaly in essential thrombocythemia are independent risk factors for hemorrhage". Eur. J. Haematol. 90 (3): 228–36. doi:10.1111/ejh.12064. PMID 23281576.
↑ Grieco A, Manna R, Mancini R, Gambassi G (April 1988). "Massive hepatomegaly following splenectomy for myeloid metaplasia". Am. J. Med. 84 (4): 797. PMID 3400674.
↑ Tefferi A, Barbui T (February 2015). "Polycythemia vera and essential thrombocythemia: 2015 update on diagnosis, risk-stratification and management". Am. J. Hematol. 90 (2): 162–73. doi:10.1002/ajh.23895. PMID 25611051.
↑ Cervantes F, Martinez-Trillos A (May 2013). "Myelofibrosis: an update on current pharmacotherapy and future directions". Expert Opin Pharmacother. 14 (7): 873–84. doi:10.1517/14656566.2013.783019. PMID 23514013.
↑ Adachi K, Ui M, Nojima H, Takada Y, Enatsu K (August 2011). "Isolated splenic peliosis presenting with giant splenomegaly and severe coagulopathy". Am. J. Surg. 202 (2): e17–9. doi:10.1016/j.amjsurg.2010.10.002. PMID 21810495.
↑ Huprikar NA, Kurtz MT, Mount CA (October 2013). "Massive splenomegaly and lymphopenia: a unique case of obstructive shock". BMJ Case Rep. 2013. doi:10.1136/bcr-2013-201643. PMC 3822246. PMID 24172780.
↑ Kumar KJ, Kumar HC, Manjunath VG, Anitha C, Mamatha S (January 2014). "Hepatitis A in children- clinical course, complications and laboratory profile". Indian J Pediatr. 81 (1): 15–9. doi:10.1007/s12098-013-1114-8. PMID 23904062.
↑ Gao LW, Xie ZD, Liu YY, Wang Y, Shen KL (February 2011). "Epidemiologic and clinical characteristics of infectious mononucleosis associated with Epstein-Barr virus infection in children in Beijing, China". World J Pediatr. 7 (1): 45–9. doi:10.1007/s12519-011-0244-1. PMID 21191775.
↑ Smiechura M, Strużycka M, Konopka W (2014). "Congenital and acquired cytomegalovirus infection and hearing evaluation in children". Otolaryngol Pol. 68 (6): 303–7. doi:10.1016/j.otpol.2014.04.003. PMID 25308607.
↑ Rosche KL, Aljasham AT, Kipfer JN, Piatkowski BT, Konjufca V (2015). "Infection with Salmonella enterica Serovar Typhimurium Leads to Increased Proportions of F4/80+ Red Pulp Macrophages and Decreased Proportions of B and T Lymphocytes in the Spleen". PLoS ONE. 10 (6): e0130092. doi:10.1371/journal.pone.0130092. PMC 4466801. PMID 26068006.
↑ Roset MS, Ibañez AE, de Souza Filho JA, Spera JM, Minatel L, Oliveira SC, Giambartolomei GH, Cassataro J, Briones G (2014). "Brucella cyclic β-1,2-glucan plays a critical role in the induction of splenomegaly in mice". PLoS ONE. 9 (7): e101279. doi:10.1371/journal.pone.0101279. PMC 4077732. PMID 24983999.
↑ Chandni R, Chandni R, Chandni R (2016). "Extra pulmonary tuberculosis presenting as fever with massive splenomegaly and pancytopenia". IDCases. 4: 20–2. doi:10.1016/j.idcr.2016.02.005. PMC 4802818. PMID 27051579.
↑ Sumbele IU, Bopda OS, Kimbi HK, Ning TR, Nkuo-Akenji T (November 2015). "Influence of Plasmodium gametocyte carriage on the prevalence of fever, splenomegaly and cardiovascular parameters in children less than 15 years in the Mount Cameroon area: cross sectional study". BMC Infect. Dis. 15: 547. doi:10.1186/s12879-015-1290-4. PMC 4661959. PMID 26612502.
↑ Pan J, Liu L, Yan YH, Shao ZW, Li Q, Zhou RH (August 2014). "[Application of health education path in advanced schistosomiasis patients with splenomegaly in perioperative period]". Zhongguo Xue Xi Chong Bing Fang Zhi Za Zhi (in Chinese). 26 (4): 425–7, 430. PMID 25434143.
↑ Oz HS (August 2014). "Novel Synergistic Protective Efficacy of Atovaquone and Diclazuril on Fetal-Maternal Toxoplasmosis". Int J Clin Med. 5 (15): 921–932. PMC 4157831. PMID 25210646.
↑ Sayyahfar S, Ansari S, Mohebali M, Behnam B (April 2014). "Visceral leishmaniasis without fever in an 11-month-old infant: a rare clinical feature of Kala-azar". Korean J. Parasitol. 52 (2): 189–91. doi:10.3347/kjp.2014.52.2.189. PMC 4028457. PMID 24850963.
↑ Francischetto O, Silva LA, Senna KM, Vasques MR, Barbosa GF, Weksler C, Ramos RG, Golebiovski WF, Lamas Cda C (October 2014). "Healthcare-associated infective endocarditis: a case series in a referral hospital from 2006 to 2011". Arq. Bras. Cardiol. 103 (4): 292–8. PMC 4206359. PMID 25352503.
↑ Balakrishnan N, Jawanda JS, Miller MB, Breitschwerdt EB (February 2013). "Bartonella henselae infection in a man with hypergammaglobulinaemia, splenomegaly and polyclonal plasmacytosis". J. Med. Microbiol. 62 (Pt 2): 338–41. doi:10.1099/jmm.0.052134-0. PMID 23118473.
↑ Ayto R, Hughes DA (2013). "Gaucher disease and myeloma". Crit Rev Oncog. 18 (3): 247–68. PMID 23510067.

[pmid22710653-1] Wu Z, Zhou J, Pankaj P, Peng B (December 2012). "Laparoscopic and open splenectomy for splenomegaly secondary to liver cirrhosis: an evaluation of immunity". Surg Endosc. 26 (12): 3557–64. doi:10.1007/s00464-012-2366-5. PMID 22710653.

[pmid26489162-2] Gedela M, Khan M, Jonsson O (September 2015). "Heart Failure". S D Med. 68 (9): 403–5, 407–9. PMID 26489162.

[pmid22481689-3] Ferri PM, Ferreira AR, Fagundes ED, Liu SM, Roquete ML, Penna FJ (2012). "Portal vein thrombosis in children and adolescents: 20 years experience of a pediatric hepatology reference center". Arq Gastroenterol. 49 (1): 69–76. PMID 22481689.

[pmid25131182-4] Ishibashi N, Maebayashi T, Aizawa T, Sakaguchi M, Abe O, Saito T, Tanaka Y (May 2015). "Myelosuppression toxicity of palliative splenic irradiation in myelofibrosis and malignant lymphoma". Hematology. 20 (4): 203–7. doi:10.1179/1607845414Y.0000000192. PMID 25131182.

[pmid26614896-5] Quest GR, Johnston JB (December 2015). "Clinical features and diagnosis of hairy cell leukemia". Best Pract Res Clin Haematol. 28 (4): 180–92. doi:10.1016/j.beha.2015.10.017. PMID 26614896.

[pmid23281576-6] Chou YS, Gau JP, Yu YB, Pai JT, Hsiao LT, Liu JH, Hong YC, Liu CY, Yang CF, Chen PM, Chiou TJ, Tzeng CH (March 2013). "Leukocytosis in polycythemia vera and splenomegaly in essential thrombocythemia are independent risk factors for hemorrhage". Eur. J. Haematol. 90 (3): 228–36. doi:10.1111/ejh.12064. PMID 23281576.

[pmid3400674-7] Grieco A, Manna R, Mancini R, Gambassi G (April 1988). "Massive hepatomegaly following splenectomy for myeloid metaplasia". Am. J. Med. 84 (4): 797. PMID 3400674.

[pmid25611051-8] Tefferi A, Barbui T (February 2015). "Polycythemia vera and essential thrombocythemia: 2015 update on diagnosis, risk-stratification and management". Am. J. Hematol. 90 (2): 162–73. doi:10.1002/ajh.23895. PMID 25611051.

[pmid23514013-9] Cervantes F, Martinez-Trillos A (May 2013). "Myelofibrosis: an update on current pharmacotherapy and future directions". Expert Opin Pharmacother. 14 (7): 873–84. doi:10.1517/14656566.2013.783019. PMID 23514013.

[pmid21810495-10] Adachi K, Ui M, Nojima H, Takada Y, Enatsu K (August 2011). "Isolated splenic peliosis presenting with giant splenomegaly and severe coagulopathy". Am. J. Surg. 202 (2): e17–9. doi:10.1016/j.amjsurg.2010.10.002. PMID 21810495.

[pmid24172780-11] Huprikar NA, Kurtz MT, Mount CA (October 2013). "Massive splenomegaly and lymphopenia: a unique case of obstructive shock". BMJ Case Rep. 2013. doi:10.1136/bcr-2013-201643. PMC 3822246. PMID 24172780.

[pmid23904062-12] Kumar KJ, Kumar HC, Manjunath VG, Anitha C, Mamatha S (January 2014). "Hepatitis A in children- clinical course, complications and laboratory profile". Indian J Pediatr. 81 (1): 15–9. doi:10.1007/s12098-013-1114-8. PMID 23904062.

[pmid21191775-13] Gao LW, Xie ZD, Liu YY, Wang Y, Shen KL (February 2011). "Epidemiologic and clinical characteristics of infectious mononucleosis associated with Epstein-Barr virus infection in children in Beijing, China". World J Pediatr. 7 (1): 45–9. doi:10.1007/s12519-011-0244-1. PMID 21191775.

[pmid25308607-14] Smiechura M, Strużycka M, Konopka W (2014). "Congenital and acquired cytomegalovirus infection and hearing evaluation in children". Otolaryngol Pol. 68 (6): 303–7. doi:10.1016/j.otpol.2014.04.003. PMID 25308607.

[pmid26068006-15] Rosche KL, Aljasham AT, Kipfer JN, Piatkowski BT, Konjufca V (2015). "Infection with Salmonella enterica Serovar Typhimurium Leads to Increased Proportions of F4/80+ Red Pulp Macrophages and Decreased Proportions of B and T Lymphocytes in the Spleen". PLoS ONE. 10 (6): e0130092. doi:10.1371/journal.pone.0130092. PMC 4466801. PMID 26068006.

[pmid24983999-16] Roset MS, Ibañez AE, de Souza Filho JA, Spera JM, Minatel L, Oliveira SC, Giambartolomei GH, Cassataro J, Briones G (2014). "Brucella cyclic β-1,2-glucan plays a critical role in the induction of splenomegaly in mice". PLoS ONE. 9 (7): e101279. doi:10.1371/journal.pone.0101279. PMC 4077732. PMID 24983999.

[pmid27051579-17] Chandni R, Chandni R, Chandni R (2016). "Extra pulmonary tuberculosis presenting as fever with massive splenomegaly and pancytopenia". IDCases. 4: 20–2. doi:10.1016/j.idcr.2016.02.005. PMC 4802818. PMID 27051579.

[pmid26612502-18] Sumbele IU, Bopda OS, Kimbi HK, Ning TR, Nkuo-Akenji T (November 2015). "Influence of Plasmodium gametocyte carriage on the prevalence of fever, splenomegaly and cardiovascular parameters in children less than 15 years in the Mount Cameroon area: cross sectional study". BMC Infect. Dis. 15: 547. doi:10.1186/s12879-015-1290-4. PMC 4661959. PMID 26612502.

[pmid25434143-19] Pan J, Liu L, Yan YH, Shao ZW, Li Q, Zhou RH (August 2014). "[Application of health education path in advanced schistosomiasis patients with splenomegaly in perioperative period]". Zhongguo Xue Xi Chong Bing Fang Zhi Za Zhi (in Chinese). 26 (4): 425–7, 430. PMID 25434143.

[pmid25210646-20] Oz HS (August 2014). "Novel Synergistic Protective Efficacy of Atovaquone and Diclazuril on Fetal-Maternal Toxoplasmosis". Int J Clin Med. 5 (15): 921–932. PMC 4157831. PMID 25210646.

[pmid24850963-21] Sayyahfar S, Ansari S, Mohebali M, Behnam B (April 2014). "Visceral leishmaniasis without fever in an 11-month-old infant: a rare clinical feature of Kala-azar". Korean J. Parasitol. 52 (2): 189–91. doi:10.3347/kjp.2014.52.2.189. PMC 4028457. PMID 24850963.

[pmid25352503-22] Francischetto O, Silva LA, Senna KM, Vasques MR, Barbosa GF, Weksler C, Ramos RG, Golebiovski WF, Lamas Cda C (October 2014). "Healthcare-associated infective endocarditis: a case series in a referral hospital from 2006 to 2011". Arq. Bras. Cardiol. 103 (4): 292–8. PMC 4206359. PMID 25352503.

[pmid23118473-23] Balakrishnan N, Jawanda JS, Miller MB, Breitschwerdt EB (February 2013). "Bartonella henselae infection in a man with hypergammaglobulinaemia, splenomegaly and polyclonal plasmacytosis". J. Med. Microbiol. 62 (Pt 2): 338–41. doi:10.1099/jmm.0.052134-0. PMID 23118473.

[pmid23510067-24] Ayto R, Hughes DA (2013). "Gaucher disease and myeloma". Crit Rev Oncog. 18 (3): 247–68. PMID 23510067.

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@@ Line 184: / Line 184: @@
 * [[Esophageal varices]]
 |-
-! rowspan="9" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Malignancy
+! rowspan="10" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Malignancy
 ! colspan="2" align="center" style="background:#DCDCDC;" |[[Lymphoma]]<ref name="pmid25131182">{{cite journal |vauthors=Ishibashi N, Maebayashi T, Aizawa T, Sakaguchi M, Abe O, Saito T, Tanaka Y |title=Myelosuppression toxicity of palliative splenic irradiation in myelofibrosis and malignant lymphoma |journal=Hematology |volume=20 |issue=4 |pages=203–7 |date=May 2015 |pmid=25131182 |doi=10.1179/1607845414Y.0000000192 |url=}}</ref>
 | align="center" style="background:#F5F5F5;" |
@@ Line 556: / Line 556: @@
 * [[Disseminated intravascular coagulation|DIC]]
 |-
-! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Category
 ! colspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Disease
 ! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Etiology
@@ Line 586: / Line 585: @@
 ! rowspan="13" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Infection
 ! rowspan="3" align="center" style="background:#DCDCDC;" |[[Virus|Viral]]
-! align="center" style="background:#DCDCDC;" |[[Hepatitis]]
+! align="center" style="background:#DCDCDC;" |[[Hepatitis]]<ref name="pmid23904062">{{cite journal |vauthors=Kumar KJ, Kumar HC, Manjunath VG, Anitha C, Mamatha S |title=Hepatitis A in children- clinical course, complications and laboratory profile |journal=Indian J Pediatr |volume=81 |issue=1 |pages=15–9 |date=January 2014 |pmid=23904062 |doi=10.1007/s12098-013-1114-8 |url=}}</ref>
 | align="center" style="background:#F5F5F5;" |
 * Infection
@@ Line 627: / Line 626: @@
 * [[Encephalomyelitis]]
 |-
-! align="center" style="background:#DCDCDC;" |[[Mononucleosis|Infectious mononucleosis]]
+! align="center" style="background:#DCDCDC;" |[[Mononucleosis|Infectious mononucleosis]]<ref name="pmid21191775">{{cite journal |vauthors=Gao LW, Xie ZD, Liu YY, Wang Y, Shen KL |title=Epidemiologic and clinical characteristics of infectious mononucleosis associated with Epstein-Barr virus infection in children in Beijing, China |journal=World J Pediatr |volume=7 |issue=1 |pages=45–9 |date=February 2011 |pmid=21191775 |doi=10.1007/s12519-011-0244-1 |url=}}</ref>
 | align="center" style="background:#F5F5F5;" |
 * EBV
@@ Line 655: / Line 654: @@
 | align="center" style="background:#F5F5F5;" |
 |-
-! align="center" style="background:#DCDCDC;" |[[Cytomegalovirus]]
+! align="center" style="background:#DCDCDC;" |[[Cytomegalovirus]]<ref name="pmid25308607">{{cite journal |vauthors=Smiechura M, Strużycka M, Konopka W |title=Congenital and acquired cytomegalovirus infection and hearing evaluation in children |journal=Otolaryngol Pol |volume=68 |issue=6 |pages=303–7 |date=2014 |pmid=25308607 |doi=10.1016/j.otpol.2014.04.003 |url=}}</ref>
 | align="center" style="background:#F5F5F5;" |
 | align="center" style="background:#F5F5F5;" |
@@ Line 683: / Line 682: @@
 |-
 ! rowspan="3" align="center" style="background:#DCDCDC;" |[[Bacteria|Bacterial]]
-! align="center" style="background:#DCDCDC;" |[[Salmonella]]
+! align="center" style="background:#DCDCDC;" |[[Salmonella]]<ref name="pmid26068006">{{cite journal |vauthors=Rosche KL, Aljasham AT, Kipfer JN, Piatkowski BT, Konjufca V |title=Infection with Salmonella enterica Serovar Typhimurium Leads to Increased Proportions of F4/80+ Red Pulp Macrophages and Decreased Proportions of B and T Lymphocytes in the Spleen |journal=PLoS ONE |volume=10 |issue=6 |pages=e0130092 |date=2015 |pmid=26068006 |pmc=4466801 |doi=10.1371/journal.pone.0130092 |url=}}</ref>
 | align="center" style="background:#F5F5F5;" |
 | align="center" style="background:#F5F5F5;" |
@@ Line 710: / Line 709: @@
 | align="center" style="background:#F5F5F5;" |
 |-
-! align="center" style="background:#DCDCDC;" |[[Brucella]]
+! align="center" style="background:#DCDCDC;" |[[Brucella]]<ref name="pmid24983999">{{cite journal |vauthors=Roset MS, Ibañez AE, de Souza Filho JA, Spera JM, Minatel L, Oliveira SC, Giambartolomei GH, Cassataro J, Briones G |title=Brucella cyclic β-1,2-glucan plays a critical role in the induction of splenomegaly in mice |journal=PLoS ONE |volume=9 |issue=7 |pages=e101279 |date=2014 |pmid=24983999 |pmc=4077732 |doi=10.1371/journal.pone.0101279 |url=}}</ref>
 | align="center" style="background:#F5F5F5;" |
 | align="center" style="background:#F5F5F5;" |
@@ Line 737: / Line 736: @@
 | align="center" style="background:#F5F5F5;" |
 |-
-! align="center" style="background:#DCDCDC;" |[[Tuberculosis]]
+! align="center" style="background:#DCDCDC;" |[[Tuberculosis]]<ref name="pmid27051579">{{cite journal |vauthors=Chandni R, Chandni R, Chandni R |title=Extra pulmonary tuberculosis presenting as fever with massive splenomegaly and pancytopenia |journal=IDCases |volume=4 |issue= |pages=20–2 |date=2016 |pmid=27051579 |pmc=4802818 |doi=10.1016/j.idcr.2016.02.005 |url=}}</ref>
 | align="center" style="background:#F5F5F5;" |
 | align="center" style="background:#F5F5F5;" |
@@ Line 765: / Line 764: @@
 |-
 ! rowspan="4" align="center" style="background:#DCDCDC;" |[[Parasitism|Parasitic]]
-! align="center" style="background:#DCDCDC;" |[[Malaria]]
+! align="center" style="background:#DCDCDC;" |[[Malaria]]<ref name="pmid26612502">{{cite journal |vauthors=Sumbele IU, Bopda OS, Kimbi HK, Ning TR, Nkuo-Akenji T |title=Influence of Plasmodium gametocyte carriage on the prevalence of fever, splenomegaly and cardiovascular parameters in children less than 15 years in the Mount Cameroon area: cross sectional study |journal=BMC Infect. Dis. |volume=15 |issue= |pages=547 |date=November 2015 |pmid=26612502 |pmc=4661959 |doi=10.1186/s12879-015-1290-4 |url=}}</ref>
 | align="center" style="background:#F5F5F5;" |
 | align="center" style="background:#F5F5F5;" |
@@ Line 792: / Line 791: @@
 | align="center" style="background:#F5F5F5;" |
 |-
-! align="center" style="background:#DCDCDC;" |[[Schistosomiasis]]
+! align="center" style="background:#DCDCDC;" |[[Schistosomiasis]]<ref name="pmid25434143">{{cite journal |vauthors=Pan J, Liu L, Yan YH, Shao ZW, Li Q, Zhou RH |title=[Application of health education path in advanced schistosomiasis patients with splenomegaly in perioperative period] |language=Chinese |journal=Zhongguo Xue Xi Chong Bing Fang Zhi Za Zhi |volume=26 |issue=4 |pages=425–7, 430 |date=August 2014 |pmid=25434143 |doi= |url=}}</ref>
 | align="center" style="background:#F5F5F5;" |
 | align="center" style="background:#F5F5F5;" |
@@ Line 819: / Line 818: @@
 | align="center" style="background:#F5F5F5;" |
 |-
-! align="center" style="background:#DCDCDC;" |[[Toxoplasmosis]]
+! align="center" style="background:#DCDCDC;" |[[Toxoplasmosis]]<ref name="pmid25210646">{{cite journal |vauthors=Oz HS |title=Novel Synergistic Protective Efficacy of Atovaquone and Diclazuril on Fetal-Maternal Toxoplasmosis |journal=Int J Clin Med |volume=5 |issue=15 |pages=921–932 |date=August 2014 |pmid=25210646 |pmc=4157831 |doi= |url=}}</ref>
 | align="center" style="background:#F5F5F5;" |
 | align="center" style="background:#F5F5F5;" |
@@ Line 846: / Line 845: @@
 | align="center" style="background:#F5F5F5;" |
 |-
-! align="center" style="background:#DCDCDC;" |[[Visceral leishmaniasis|Kala-azar]]
+! align="center" style="background:#DCDCDC;" |[[Visceral leishmaniasis|Kala-azar]]<ref name="pmid24850963">{{cite journal |vauthors=Sayyahfar S, Ansari S, Mohebali M, Behnam B |title=Visceral leishmaniasis without fever in an 11-month-old infant: a rare clinical feature of Kala-azar |journal=Korean J. Parasitol. |volume=52 |issue=2 |pages=189–91 |date=April 2014 |pmid=24850963 |pmc=4028457 |doi=10.3347/kjp.2014.52.2.189 |url=}}</ref>
 | align="center" style="background:#F5F5F5;" |[[Visceral leishmaniasis]]
 | align="center" style="background:#F5F5F5;" |
@@ Line 873: / Line 872: @@
 | align="center" style="background:#F5F5F5;" |
 |-
-! colspan="2" align="center" style="background:#DCDCDC;" |[[Endocarditis|Infective endocarditis]]
+! colspan="2" align="center" style="background:#DCDCDC;" |[[Endocarditis|Infective endocarditis]]<ref name="pmid25352503">{{cite journal |vauthors=Francischetto O, Silva LA, Senna KM, Vasques MR, Barbosa GF, Weksler C, Ramos RG, Golebiovski WF, Lamas Cda C |title=Healthcare-associated infective endocarditis: a case series in a referral hospital from 2006 to 2011 |journal=Arq. Bras. Cardiol. |volume=103 |issue=4 |pages=292–8 |date=October 2014 |pmid=25352503 |pmc=4206359 |doi= |url=}}</ref>
 | align="center" style="background:#F5F5F5;" |
 | align="center" style="background:#F5F5F5;" |
@@ Line 900: / Line 899: @@
 | align="center" style="background:#F5F5F5;" |
 |-
-! colspan="2" align="center" style="background:#DCDCDC;" |[[Fungus|Fungal]]
+! colspan="2" align="center" style="background:#DCDCDC;" |[[Fungus|Fungal]]<ref name="pmid23118473">{{cite journal |vauthors=Balakrishnan N, Jawanda JS, Miller MB, Breitschwerdt EB |title=Bartonella henselae infection in a man with hypergammaglobulinaemia, splenomegaly and polyclonal plasmacytosis |journal=J. Med. Microbiol. |volume=62 |issue=Pt 2 |pages=338–41 |date=February 2013 |pmid=23118473 |doi=10.1099/jmm.0.052134-0 |url=}}</ref>
 | align="center" style="background:#F5F5F5;" |
 | align="center" style="background:#F5F5F5;" |
@@ Line 1,094: / Line 1,093: @@
 * [[Infection|Infections]]
 |-
-! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Category
+! rowspan="7" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Infiltrative
 ! colspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Disease
 ! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Etiology
@@ Line 1,122: / Line 1,121: @@
 ! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Associated findings
 |-
-! rowspan="6" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Infiltrative
 ! colspan="2" align="center" style="background:#DCDCDC;" |[[Gaucher's disease|Gaucher disease]]<ref name="pmid23510067">{{cite journal |vauthors=Ayto R, Hughes DA |title=Gaucher disease and myeloma |journal=Crit Rev Oncog |volume=18 |issue=3 |pages=247–68 |date=2013 |pmid=23510067 |doi= |url=}}</ref>
 | align="center" style="background:#F5F5F5;" |