Splenomegaly
Definition: palpable spleen.
The normal spleen is 12 by 7 by 4 cm. Splenomegaly is
measured in cm below the costal margin.
Differentials: enlarged kidney, colonic mass,
gastric mass, mass in tail of pancreas.
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Spleen
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Kidney
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Enlarges toward the
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Right iliac fossa
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Left iliac fossa
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Bimanually palpable
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No
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Yes
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Moves down with inspiration
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Yes
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Slightly
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Can get above it
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No
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Usually
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Medial notch
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Sometimes
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No
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Percussion note
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dull
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resonant (overlying bowel)
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Causes:
- huge spleen (> 8 cm)
- chronic myeloid leukaemia
- myelofibrosis
- malaria
- kala-azar
- moderately enlarged spleen (< 8 and > 4 cm)
- portal hypertension
- reticuloedothelial dissease
(e.g., chronic lymphocytic leukaemia, lymphoma)
- storage diseases
- slightly enlarged spleen (< 4 cm)
- infectious mononucleosis
- typhoid
- sepsis (incl. bacterial endocarditis)
- infectious hepatitis
- haemolysis (e.g., congenital spherocytosis)
- rheumatoid arthritis and Felty's syndrome
- collagen vascular disease
- brucellosis
- multiple myeloma
- sarcoidosis
- idiopathic thrombocytopaenia
- pernicious anaemia
Complications:
- Hypersplenism
Hypersplenism
Any cause of splenomegaly can cause hypersplenism.