Key Takeaways

✅ An enlarged spleen is a common imaging finding and has many possible causes.

✅ Splenomegaly most often occurs as a secondary manifestation of a primary disease process.

✅ The most common cause is portal hypertension, often associated with liver cirrhosis.

✅ A single radiological definition of normal splenic size has not been adopted; typical definition of splenomegaly is craniocaudal length > 13 cm.

✅ Massive splenomegaly is often defined as clinically palpable > 8 cm below left costal margin.

✅ Splenomegaly may be classified according to underlying pathophysiological mechanism:

• Increased splenic function (work hypertrophy)
• Infiltration (cells and/or extracellular substances)
• Congestion

✅ Splenomegaly can also be classified according to underlying condition:

• Hematologic
• Infectious
• Congestive
• Inflammatory
• Neoplastic
• Infiltrative

✅ Imaging is required to confirm splenomegaly. Options include:

• Ultrasound
• CT scan with contrast

✅ Initial testing is context dependent but typically involves:

• Hematology
  • CBC
  • Peripheral smear
  • PT, aPTT
• Biochemistry:
  • BUN and creatinine
  • Liver function tests
  • CRP
  • LDH
  • Vitamin B12
• Microbiology (if indicated)
  • Monospot test
  • Serology for:
    • HIV
    • CMV
    • Toxoplasmosis
    • Brucella
• Immunology (if indicated)
  • ANA
  • Rheumatoid factor

✅ Treatment is usually directed at the underlying cause. Spleen reduction therapies or Radical splenectomy may be indicated in selected cases.