Splenomegaly is an enlargement of the spleen, which usually lies in the left upper quadrant (LUQ) of the human abdomen. It is one of the cardinal signs of hypersplenism (This is a pancytopenia occurring in patients with an enlarged spleen - due to large numbers of cells being pooled and destroyed in the spleen's reticuloendothelial system, and haemodilution because of an increased plasma volume). Splenomegaly is usually associated with increased workload (such as in hemolytic anemias), which suggests that it is a response to hyperfunction. It is therefore not surprising that splenomegaly is associated with any disease process that involves abnormal red blood cells being destroyed in the spleen. Other common causes include congestion due to portal hypertension and infitration by leukemias and lymphomas.

Signs of splenomegaly may include a palpable left upper quadrant abdominal mass or splenic rub. Patients may also be cytopenic. Patients with splenomegaly may present with abdominal pain, early satiety due to splenic encroachment, and may complain of the symptoms of anemia due to accompanying cytopenia. It can be detected by physicians on physical examination, but an ultrasound can be used to confirm diagnosis.

Causes

Splenomegaly grouped on the basis of the pathogenic mechanism

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

Chronic myelogenous leukemia
lymphomas
hairy cell leukemia
myelofibrosis
polycythemia vera
Gauchers disease
chronic lymphocytic leukemia
sarcoidosis
autoimmune hemolytic anemia
Malaria

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.