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.

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