Knowledge Check

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Sort the causes of splenomegaly into the most appropriate mechanistic bucket:

Hemoglobinopathies
Leukemia
HLH
Primary vascular neoplasms
Portal vein thrombosis
Lymphoma
Extramedullary hematopoiesis
Metastatic lesions
Gaucher disease
Pseudocysts
Splenic abscesses
Infections
Membranopathies
True cysts
Chronic inflammation
Cirrhosis
Work hypertrophy
Infiltration
Congestion

Splenic weight he gold-standard definition of splenomegaly. However, it can only be determined after splenectomy or during post mortem exam, making diagnosis of splenomegaly based on splenic weight impractical. That being said, what spleen weight qualifies as splenomegaly?

a
100 grams
b
250 g
c
400 grams

It is named for Ludwig Traube, although it was first described by his pupil in 1868. Another method was described by Donald O. Castell in 1967 (Castell’s sign). Dullness to percussion over Traube’s space may indicate splenomegaly, although this can also be a normal finding after a meal or may indicate certain pathologies, e.g. enlarged left lobe of the liver, a fundus mass, a left pleural effusion or a massive pericardial effusion.
Source: JAMA. 1993;270:2218-21.

True or false: autoimmune hemolytic anemia and immune thrombocytopenia may be associated with splenomeagly.

a
True
Splenomegaly reported in about 20% of patients with chronic autoimmune disorders, secondary at least in part to follicular hyperplasia due to antigenic stimulation.
b
False

True or false: sickle cell disease is never associated with splenomegaly, only with asplenia.

a
True
b
False
Moderate splenomegaly (1-2 cm below the left costal margin) occurs early in life before the spleen atrophies; splenomegaly may also occur in acute splenic sequestration.

Which conditions are associated with massive splenomegaly?

a
Chronic myelogenous leukemia (CML)
b
Agnogenic myeloid metaplasia (myelofibrosis)
c
Thyrotoxicosis
d
Indolent lymphomas
e
Hairy cell leukemia
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