Splenomegaly

Splenomegaly is an enlargement of the spleen beyond its normal size. Hepatosplenomegaly is enlargement of both the liver and the spleen.

The spleen is an organ involved in the production and maintenance of red blood cells, the production of certain circulating white blood cells, and is a part of the lymph system and the immune system. It also has a phagocytic role and acts as a filter for circulating microorganisms, old and deformed red cells, and other antigens.

Because of its wide variety of functions, the spleen may be affected by many conditions involving the blood or lymph system, and by infection, malignancies, liver disease and parasites. The liver is involved in a multitude of bodily functions, and is affected by a variety of conditions, many of which result in hepatomegaly.

Causes

The liver is involved in a multitude of bodily functions, and is affected by a variety of conditions, many of which result in hepatomegaly. The main causes of splenomegaly include:

  • Infection
    a. Viral: EBV, CMV, parvovirus 19, HIV 
    b. Bacterial: typhoid fever, SBE, septicemia, cat scratch, TB 
    c. Protozoal: malaria
    d. Fungal: histoplasmosis, coccidiodmycosis
  • Haematological disorders
    a. Haemolytic disorders: autoimmune, red cell membrane defects including spherocytosis, elliptocytosis, G6PD, pyruvate kinase deficiency
    b. Haemoglobinopathies: sickle cell syndromes, thalassemia syndromes
    c. Extramedullary haematopoiesis- Thalassemia and osteopetrosis
  • Splenic infiltration
    a. Gaucher's and Niemann-Pick
    b. Leukemic infiltration 
    c. Hodgkin's disease
  • Lupus, JRA, Sarcoidosis
  • Trauma
  • Splenic cysts, haemangiomas
  • Disorders of splenic blood flow
    a. Cavernous transformation of the portal vein
    b. Hepatic cirrhosis
    c. Portal and/or splenic vein thrombosis

Diagnosis

Diagnosing splenomegaly involves a number of tests, including:

  • Clinical history
  • Physical examination
  • Ultrasound or abdominal X-ray
  • Computerised tomography (CT) scan
  • Blood tests to check for underlying disorders.

Treatment

Depending on the cause.