Splenomegaly

Splenomegaly
Massively enlarged spleen, the result of extramedullary hematopoiesis, is outlined above. This patient's left upper quadrant appears more full than the corresponding area on the right. Image courtesy of Charlie Goldberg, M.D., UCSD School of Medicine and VA Medical Center, San Diego, California
ICD-10	Q89.0, R16.1
ICD-9	759.0, 789.2
DiseasesDB	12375
MedlinePlus	003276
MeSH	D013163

Template:Splenomegaly 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

Complete differential diagnosis splenomegaly in alphabetical order

In alphabetical order.

• AIDS
• Angioimmunoblastic lymphoanedopathy
• Angiosarcoma
• Autoimmune hemolytic anemia
• Bacterial septicemia
• Bone marrow damage
• Bone marrow infiltration
• Brucellosis
• Castleman's syndrome
• Cavernous transformation of the portal vein
• Cellular infiltration
• Chronic myoletic leukemia
• Collagen vascular diseases
• Congestive heart failure
• Constrictive pericarditis
• Coronavirus
• Corynebacterium diphtheriae
• Cytomegalovirus
• Early sickle cell anemia
• Endocarditis
• Ehrlichiosis
• Eosinophillic granuloma
• Epstein-Barr Virus Infection
• Felty's syndrome
• Fever unknown origin
• Fibromas
• Fungal infections
• Gaucher's disease
• Hemangiomas
• Hamartomas
• Hemoglobinopathy
• Hemolytic anemia
• Hepatic echinococcosis
• Hepatic schistomasis
• Hepatic vein obstruction
• Hepatitis
• Hereditary spherocytosis
• Histiocytosis
• Histoplasmosis
• HIV
• Hodgkin's lymphoma
• Hurler's syndrome
• Hyperlipidemias
• Idiopathic splenomegaly
• Immune hemolytic anemias
• Infective Endocarditis
• Infectious mononucleosis
• Interleukin-2
• Iron deficiency anemia
• Leishmaniasis
• Letterer-Siwe disease
• Leukemia
• Lymphangiomas
• Lymphoid leukemia
• Lympho-reticulosarcoma
• Malaria
• Malignancy
• Melanoma
• Myelofibrosis
• Myeloid leukemia
• Myeloid metaplasia
• Monocytic leukemia
• Mononucleosis
• Myobacterium avium complex
• Myoproliferative syndrome(s)
• Niemann-Pick disease
• Non-Hodgkin's lymphoma
• Nutritional anemias
• Osteomyelosclerosis
• Paroxysmal nocturnal hemoglobinuria
• Polycythemia vera
• Portal hypertension
• Q fever
• Radiation
• Rheumatoid arthritis
• RMSF
• Sarcoidosis
• Schistosomiasis
• Serum sickness
• Sickle cell disease
• Splenic abscess
• Splenic artery anuerysm
• Splenic cysts
• Splenic hamartoma
• Splenic hemangioma
• Splenic vein obstruction/thrombosis
• Stillness disease
• Subacute bacterial endocarditis
• Syphillis
• Systemic lupus erythematosus
• Tangier disease
• Thalassemia major
• Thyrotoxicosis
• Toxoplasmosis
• Trauma
• Trypanosomiasis
• Tuberculosis
• Tumors
• Typhoid fever
• Vein obstruction
• Viral hepatitis
• Weil's disease
• Less common causes

  • Amyloidosis
  • Babesiosis
  • Gaucher's disease
  • Histoplasmosis
  • Kala-azar
  • Rickets
  • Schistosomiasis
  • Syphilis
  • Toxoplasmosis
  • Typhoid fever

Differential diagnosis of causes by organ system or pathogenesis

Splenomegaly grouped on the basis of the pathogenic mechanism

Increased function	Abnormal blood flow	Infitration
Removal of defective RBCs Spherocytosis Thalassemia Hemoglobinopathies Nutritional anemias early sickle cell anemia Immune hyperplasia Response to infection (viral,bacterial,fungal,parasitic) Mononucleosis, AIDS, viral hepatitis subacute bacterial endocarditis, bacterial septicemia splenic abscess, typhoid fever brucellosis,leptospirosis, tuberculosis histoplasmosis malaria, leishmaniasis, trypanosomiasis ehrlichiosis Disordered immunoregulation Rheumatoid arthritis SLE Serum sickness Autoimmune hemolytic anemia Immune thrombocytopenia sarcoidosis drug reactions Extramedullary hematopoiesis Myelofibrosis Marrow infiltration by tumors, leukemias marrow damage by radiation, toxins	Organ Failure Cirrhosis congestive heart failure Vascular hepatic vein obstruction portal vein obstruction Budd-Chiari syndrome splenic vein obstruction Infections hepatic schistosomiasis hepatic echinococcosis	Metabolic diseases Gauchers disease Niemann-Pick disease Hurler syndrome and other Mucopolysaccharidoses Amyloidosis Tangier disease Benign and malignant infiltrations Leukemias(acute,chronic,lymphoid and myeloid) lymphomas(Hodgkins and non-hodgkins) myeloproliferative disorders metastatic tumors(commonly melanoma) histiocytosis X Hemangioma,lymphangioma splenic cysts hamartomas eosinophilic granuloma

The causes of massive splenomegaly (>1000gms) are much fewer and include:

Thalassemia
Kala-Azar (Leishmaniasis)
Portal hypertension of Bilharziasis
Chronic myelogenous leukemia
lymphomas
hairy cell leukemia
myelofibrosis
polycythemia vera
Gauchers disease
chronic lymphocytic leukemia
sarcoidosis
autoimmune hemolytic anemia
Malaria

Clinical presentation

Symptoms may include abdominal 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 or Traube's space, but an ultrasound can be used to confirm diagnosis.

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Treatment

If the splenomegaly underlies hypersplenism, a splenectomy is indicated and will correct the problem. After splenectomy, however, patients have an increased risk for infectious diseases.

After splenectomy, patients should be vaccinated against Haemophilus influenzae and Streptococcus pneumoniae. They should receive annual influenza vaccinations. Long-term prophylactic antibiotics should be given.

Related chapters

• sign (medicine)
• Hepatosplenomegaly

Resources

• PatientPlus Splenomegaly and hypersplenism
• Template:MerckManual (Hypersplenism)

References

Template:WikiDoc Sources