Splenomegaly: Difference between revisions

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__NOTOC__
__NOTOC__
'''For the patient information page for this topic, click [[Splenomegaly (patient information)|here]]'''


{{CMG}}; {{AE}} {{SSH}}, Gichoya Judy Wawira [mailto:judywawira@gmail.com],  
{{CMG}}; {{AE}} {{SSH}}, Gichoya Judy Wawira [mailto:judywawira@gmail.com],  
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{{SK}} Spleen enlargement; enlarged spleen; spleen swelling
{{SK}} Spleen enlargement; enlarged spleen; spleen swelling


==Overview==
==Pathophysiology==
==Causes==
The causes of splenomegaly vary widely and range from increased splenic function (such as [[hemoglobinopathies]]), splenic congestion due to abnormal blood flow (such as venous obstruction), and splenic infiltration (such as storage disorders and [[malignancies]]).
===Causes by Pathogenesis===
{| class="wikitable"
|-
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Mechanism
! colspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" + |Pathogenesis
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Example
|-
! rowspan="5" align="center" style="background:#4479BA; color: #FFFFFF;" + |Increased function
! colspan="2" |Removal of defective RBCs
|<div style="-moz-column-count:2; column-count:2;">
*[[Spherocytosis]]
*[[Thalassemia]]
*[[Hemoglobinopathy]]
*[[Anemia]]
*[[Sickle cell anemia]]</div>
|-
! rowspan="3" |Immune hyperplasia
!Response to infection (viral, bacterial, fungal, parasitic)
|<div style="-moz-column-count:2; column-count:2;">
*[[Mononucleosis]]
*[[AIDS]]
*[[Viral hepatitis]]
*[[Endocarditis|Subacute bacterial endocarditis]]
*[[Sepsis|Bacterial septicemia]]
*[[Splenic abscess]]
*[[Typhoid fever]]
*[[Leptospirosis]]
*[[Tuberculosis]]
*[[Histoplasmosis]]
*[[Malaria]]
*[[leishmaniasis]]
*[[Trypanosomiasis]]
*[[Ehrlichiosis]]</div>
|-
!Disordered immunoregulation
|<div style="-moz-column-count:2; column-count:2;">
*[[Rheumatoid arthritis]]
*[[SLE]]
*[[Serum sickness]]
*[[Autoimmune hemolytic anemia]]
*[[Idiopathic thrombocytopenic purpura|Immune thrombocytopenia]]
*[[Sarcoidosis]]</div>
|-
!Drug reactions
|
*[[Cidofovir]]
*[[Filgrastim]]
|-
! colspan="2" |Extramedullary hematopoiesis
|<div style="-moz-column-count:2; column-count:2;">
*[[Myelofibrosis]]
*[[Tumors]]
*[[Marrow infiltration by tumors, leukemias|Lukemias]]
*[[marrow damage by radiation, toxins|Marrow damage by radiation]]
*[[marrow damage by radiation, toxins|toxins]]</div>
|-
! rowspan="3" align="center" style="background:#4479BA; color: #FFFFFF;" + |Abnormal blood flow
! colspan="2" |Organ Failure
|
*[[Cirrhosis]]
*[[Congestive heart failure]]
|-
! colspan="2" |Vascular
|<div style="-moz-column-count:2; column-count:2;">
*[[Hepatic vein obstruction]]
*[[Portal vein thrombosis|Portal vein obstruction]]
*[[Budd-Chiari syndrome]]
*Splenic vein obstruction</div>
|-
! colspan="2" |Infections
|
*Hepatic [[schistosomiasis]]
*Hepatic [[echinococcosis]]
|-
! rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" + |Infiltration
! colspan="2" |Metabolic diseases
|<div style="-moz-column-count:2; column-count:2;">
*[[Gauchers disease]]
*[[Niemann-Pick disease]]
*[[Hurler syndrome]]
*[[Mucopolysaccharidoses]]
*[[Amyloidosis]]
*[[Tangier disease]]</div>
|-
! colspan="2" |Benign and malignant infiltrations
|<div style="-moz-column-count:2; column-count:2;">
*[[Leukemias]] ([[acute]], [[chronic]], [[lymphoid]] and [[myeloid]])
*[[Lymphomas]] ([[Hodgkins]] and [[Non-Hodgkin lymphoma|non-hodgkins]])
*[[Myeloproliferative]] disorders
*[[Metastatic]] tumors (commonly [[melanoma]])
*[[Histiocytosis X]]
*[[Hemangioma]]
*[[Lymphangioma]]
*[[Splenic cyst]]
*[[Hamartomas]]
*[[Eosinophilic granuloma]]</div>
|}
==Differentiating Splenomegaly from Other Diseases==
==Differentiating Splenomegaly from Other Diseases==
{|  
{|  
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* [[Alcohol]]
* [[Alcohol]]
* [[Autoimmunity|Autoimmune]]
* [[Autoimmunity|Autoimmune]]
| align="center" style="background:#F5F5F5;" |Any, more in elderly
| align="center" style="background:#F5F5F5;" |Any age, more common in elderly
| align="left" style="background:#F5F5F5;" |
| align="left" style="background:#F5F5F5;" |
* [[Hepatitis]]
* [[Hepatitis]]
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| align="left" style="background:#F5F5F5;" |
| align="left" style="background:#F5F5F5;" |
* [[Thrombosis]]
* [[Thrombosis]]
| align="center" style="background:#F5F5F5;" |Any
| align="center" style="background:#F5F5F5;" |Any age
| align="left" style="background:#F5F5F5;" |
| align="left" style="background:#F5F5F5;" |
* [[Inflammation]]
* [[Inflammation]]
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* [[Mutation]]
* [[Mutation]]
* [[Infection]]
* [[Infection]]
| align="center" style="background:#F5F5F5;" |Any, most common malignant splenic tumor
| align="center" style="background:#F5F5F5;" |Any age, most common malignant splenic tumor
| align="left" style="background:#F5F5F5;" |
| align="left" style="background:#F5F5F5;" |
* [[Epstein Barr virus]]
* [[Epstein Barr virus]]
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| align="left" style="background:#F5F5F5;" |
| align="left" style="background:#F5F5F5;" |
* Autonomous [[erythrocyte]]<nowiki/>production
* Autonomous [[erythrocyte]]<nowiki/>production
* [[JAK2]]<nowiki/>mutation  
* [[JAK2]]<nowiki/>mutation
| align="center" style="background:#F5F5F5;" |Mean age >60 years old
| align="center" style="background:#F5F5F5;" |Mean age >60 years old
| align="left" style="background:#F5F5F5;" |
| align="left" style="background:#F5F5F5;" |
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* [[Mutation]]
* [[Mutation]]
* [[Infection]]
* [[Infection]]
| align="center" style="background:#F5F5F5;" |Any, more in adults
| align="center" style="background:#F5F5F5;" |Any age, more common in adults
| align="left" style="background:#F5F5F5;" |
| align="left" style="background:#F5F5F5;" |
* Exposure to chemicals
* Exposure to chemicals
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| align="center" style="background:#F5F5F5;" |–
| align="center" style="background:#F5F5F5;" |–
| align="left" style="background:#F5F5F5;" |
| align="left" style="background:#F5F5F5;" |
* Lymphadenopathy
* [[Lymphadenopathy]]
* Dyspnea
* [[Dyspnea]]
* Shoulder pain
* Shoulder pain
* Constipation
* [[Constipation]]
* Cachexia  
* [[Cachexia]]
* Pleural infusion
* [[Pleural effusion]]
| align="center" style="background:#F5F5F5;" |↓
| align="center" style="background:#F5F5F5;" |↓
| align="center" style="background:#F5F5F5;" |↓
| align="center" style="background:#F5F5F5;" |↓
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* Ineffective [[hematopoiesis]]
* Ineffective [[hematopoiesis]]
* [[Immunity (medical)|Immune]] mediated
* [[Immunity (medical)|Immune]] mediated
| align="center" style="background:#F5F5F5;" |Any, more in adults
| align="center" style="background:#F5F5F5;" |Any age, more in adults
| align="left" style="background:#F5F5F5;" |
| align="left" style="background:#F5F5F5;" |
* Exposure to chemicals
* Exposure to chemicals
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! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Associated findings
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Associated findings
|-
|-
! rowspan="13" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Infection
! rowspan="9" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Infection
! rowspan="3" align="center" style="background:#DCDCDC;" |[[Virus|Viral]]
! rowspan="3" align="center" style="background:#DCDCDC;" |[[Virus|Viral]]
! align="center" style="background:#DCDCDC;" |[[Hepatitis]]<ref name="pmid23904062">{{cite journal |vauthors=Kumar KJ, Kumar HC, Manjunath VG, Anitha C, Mamatha S |title=Hepatitis A in children- clinical course, complications and laboratory profile |journal=Indian J Pediatr |volume=81 |issue=1 |pages=15–9 |date=January 2014 |pmid=23904062 |doi=10.1007/s12098-013-1114-8 |url=}}</ref>
! align="center" style="background:#DCDCDC;" |[[Hepatitis]]<ref name="pmid23904062">{{cite journal |vauthors=Kumar KJ, Kumar HC, Manjunath VG, Anitha C, Mamatha S |title=Hepatitis A in children- clinical course, complications and laboratory profile |journal=Indian J Pediatr |volume=81 |issue=1 |pages=15–9 |date=January 2014 |pmid=23904062 |doi=10.1007/s12098-013-1114-8 |url=}}</ref>
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* [[Infection]]
* [[Infection]]
* [[Autoimmunity|Autoimmune]]
* [[Autoimmunity|Autoimmune]]
| align="center" style="background:#F5F5F5;" |Any
| align="center" style="background:#F5F5F5;" |
* Any age
| align="left" style="background:#F5F5F5;" |
| align="left" style="background:#F5F5F5;" |
* High risk behaviors
* High risk behaviors
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| align="left" style="background:#F5F5F5;" |
| align="left" style="background:#F5F5F5;" |
* [[Pancytopenia]]
* [[Pancytopenia]]
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |NA
| align="center" style="background:#F5F5F5;" |Clinical manifestation + lab tests
| align="center" style="background:#F5F5F5;" |Clinical manifestation + lab tests
| align="left" style="background:#F5F5F5;" |
| align="left" style="background:#F5F5F5;" |
Line 631: Line 738:
| align="left" style="background:#F5F5F5;" |
| align="left" style="background:#F5F5F5;" |
* [[Epstein Barr virus|EBV]]
* [[Epstein Barr virus|EBV]]
| align="center" style="background:#F5F5F5;" |More in children and young adults
| align="center" style="background:#F5F5F5;" |
* More common in children and young adults
| align="left" style="background:#F5F5F5;" |
| align="left" style="background:#F5F5F5;" |
* Close contact
* Close contact
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| align="center" style="background:#F5F5F5;" |Nl
| align="center" style="background:#F5F5F5;" |Nl
| align="center" style="background:#F5F5F5;" |NA
| align="center" style="background:#F5F5F5;" |NA
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |NA
| align="center" style="background:#F5F5F5;" |Clinical manifestation + [[heterophile antibody test]]
| align="center" style="background:#F5F5F5;" |Clinical manifestation + [[heterophile antibody test]]
| align="left" style="background:#F5F5F5;" |
| align="left" style="background:#F5F5F5;" |
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| align="left" style="background:#F5F5F5;" |
| align="left" style="background:#F5F5F5;" |
* [[Cytomegalovirus infection|CMV]]
* [[Cytomegalovirus infection|CMV]]
| align="center" style="background:#F5F5F5;" |More in immunocompromised patients and during pregnancy
| align="center" style="background:#F5F5F5;" |
* More common in:
** Immunocompromised patients
** During pregnancy
| align="left" style="background:#F5F5F5;" |
| align="left" style="background:#F5F5F5;" |
* Close contact
* Close contact
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| align="center" style="background:#F5F5F5;" |Nl
| align="center" style="background:#F5F5F5;" |Nl
| align="center" style="background:#F5F5F5;" |NA
| align="center" style="background:#F5F5F5;" |NA
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |NA
| align="center" style="background:#F5F5F5;" |[[Enzyme linked immunosorbent assay (ELISA)|ELISA]]
| align="center" style="background:#F5F5F5;" |[[Enzyme linked immunosorbent assay (ELISA)|ELISA]]
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
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* [[Salmonella]]  
* [[Salmonella]]  
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
* Any age
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
* Eating contaminated meat, eggs, or milk
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" |–
| align="center" style="background:#F5F5F5;" |Nl
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" |–
| align="center" style="background:#F5F5F5;" |↓
| align="center" style="background:#F5F5F5;" |Nl
| align="center" style="background:#F5F5F5;" |–
| align="center" style="background:#F5F5F5;" |–
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
* Diarrhea
* Abdominal cramps
* Vomiting
* Dehydration
| align="center" style="background:#F5F5F5;" |↑
| align="center" style="background:#F5F5F5;" |Nl
| align="center" style="background:#F5F5F5;" |↑
| align="center" style="background:#F5F5F5;" |Nl
| align="center" style="background:#F5F5F5;" |Nl
| align="center" style="background:#F5F5F5;" |Nl
| align="center" style="background:#F5F5F5;" |↑
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
* [[Oliguria]]
| align="center" style="background:#F5F5F5;" |NA
| align="center" style="background:#F5F5F5;" |NA
| align="center" style="background:#F5F5F5;" |Stool test
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
* Typhoid fever
| align="center" style="background:#F5F5F5;" |
* Reactive arthritis
| align="center" style="background:#F5F5F5;" |
* Irritable bowel syndrome
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
|-
|-
! align="center" style="background:#DCDCDC;" |[[Brucella]]<ref name="pmid24983999">{{cite journal |vauthors=Roset MS, Ibañez AE, de Souza Filho JA, Spera JM, Minatel L, Oliveira SC, Giambartolomei GH, Cassataro J, Briones G |title=Brucella cyclic β-1,2-glucan plays a critical role in the induction of splenomegaly in mice |journal=PLoS ONE |volume=9 |issue=7 |pages=e101279 |date=2014 |pmid=24983999 |pmc=4077732 |doi=10.1371/journal.pone.0101279 |url=}}</ref>
! align="center" style="background:#DCDCDC;" |[[Brucella]]<ref name="pmid24983999">{{cite journal |vauthors=Roset MS, Ibañez AE, de Souza Filho JA, Spera JM, Minatel L, Oliveira SC, Giambartolomei GH, Cassataro J, Briones G |title=Brucella cyclic β-1,2-glucan plays a critical role in the induction of splenomegaly in mice |journal=PLoS ONE |volume=9 |issue=7 |pages=e101279 |date=2014 |pmid=24983999 |pmc=4077732 |doi=10.1371/journal.pone.0101279 |url=}}</ref>
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
* Brucella
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
* Any age
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
* Ingesting contaminated food such as unpasteurized milk products
* Direct contact with an infected animal
* Inhalation of aerosols
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" |Nl
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" |–
| align="center" style="background:#F5F5F5;" |↓
| align="center" style="background:#F5F5F5;" |Nl
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" |–
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
* Headache
* Vomiting
* Diarrhea
* Constipation
* Arthralgia
* Night sweats
* Anorexia
* Foul-smelling perspiration
| align="center" style="background:#F5F5F5;" |↑
| align="center" style="background:#F5F5F5;" |Nl
| align="center" style="background:#F5F5F5;" |↑
| align="center" style="background:#F5F5F5;" |Nl
| align="center" style="background:#F5F5F5;" |↑
| align="center" style="background:#F5F5F5;" |Nl
| align="center" style="background:#F5F5F5;" |Nl
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
* [[Oliguria]]
| align="center" style="background:#F5F5F5;" |NA
| align="center" style="background:#F5F5F5;" |NA
| align="center" style="background:#F5F5F5;" |Blood culture
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
* Arthritis
| align="center" style="background:#F5F5F5;" |
* Epididymo-orchitis
| align="center" style="background:#F5F5F5;" |
* Spondylitis
| align="center" style="background:#F5F5F5;" |
* Neurobrucellosis
| align="center" style="background:#F5F5F5;" |
* Liver abscess formation
| align="center" style="background:#F5F5F5;" |
* Endocarditis
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
|-
|-
! align="center" style="background:#DCDCDC;" |[[Tuberculosis]]<ref name="pmid27051579">{{cite journal |vauthors=Chandni R, Chandni R, Chandni R |title=Extra pulmonary tuberculosis presenting as fever with massive splenomegaly and pancytopenia |journal=IDCases |volume=4 |issue= |pages=20–2 |date=2016 |pmid=27051579 |pmc=4802818 |doi=10.1016/j.idcr.2016.02.005 |url=}}</ref>
! align="center" style="background:#DCDCDC;" |[[Tuberculosis]]<ref name="pmid27051579">{{cite journal |vauthors=Chandni R, Chandni R, Chandni R |title=Extra pulmonary tuberculosis presenting as fever with massive splenomegaly and pancytopenia |journal=IDCases |volume=4 |issue= |pages=20–2 |date=2016 |pmid=27051579 |pmc=4802818 |doi=10.1016/j.idcr.2016.02.005 |url=}}</ref>
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
* Mycobacterium tuberculosis
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
* Any age
* More common in developing countries and among immunocompromised patients
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
* Close contact
* HIV
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" |↓
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" |–
| align="center" style="background:#F5F5F5;" |↓
| align="center" style="background:#F5F5F5;" |Nl
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" |–
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
* Chronic cough with blood-containing sputum
* Night sweats
* Anorexia
* Chest pain
| align="center" style="background:#F5F5F5;" |↑
| align="center" style="background:#F5F5F5;" |Nl
| align="center" style="background:#F5F5F5;" |↑
| align="center" style="background:#F5F5F5;" |Nl
| align="center" style="background:#F5F5F5;" |↑
| align="center" style="background:#F5F5F5;" |↑
| align="center" style="background:#F5F5F5;" |↑
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
* [[Oliguria]]
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
* Acid-fast bacillus
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
* Cavity on chest x ray
| align="center" style="background:#F5F5F5;" |Identifying M. tuberculosis in a clinical sample
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
* Tuberculous meningitis
| align="center" style="background:#F5F5F5;" |
* Urogenital tuberculosis
| align="center" style="background:#F5F5F5;" |
* Pott disease
| align="center" style="background:#F5F5F5;" |
* Miliary tuberculosis
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
|-
|-
! rowspan="4" align="center" style="background:#DCDCDC;" |[[Parasitism|Parasitic]]  
! rowspan="2" align="center" style="background:#DCDCDC;" |[[Parasitism|Parasitic]]  
! align="center" style="background:#DCDCDC;" |[[Malaria]]<ref name="pmid26612502">{{cite journal |vauthors=Sumbele IU, Bopda OS, Kimbi HK, Ning TR, Nkuo-Akenji T |title=Influence of Plasmodium gametocyte carriage on the prevalence of fever, splenomegaly and cardiovascular parameters in children less than 15 years in the Mount Cameroon area: cross sectional study |journal=BMC Infect. Dis. |volume=15 |issue= |pages=547 |date=November 2015 |pmid=26612502 |pmc=4661959 |doi=10.1186/s12879-015-1290-4 |url=}}</ref>
! align="center" style="background:#DCDCDC;" |[[Malaria]]<ref name="pmid26612502">{{cite journal |vauthors=Sumbele IU, Bopda OS, Kimbi HK, Ning TR, Nkuo-Akenji T |title=Influence of Plasmodium gametocyte carriage on the prevalence of fever, splenomegaly and cardiovascular parameters in children less than 15 years in the Mount Cameroon area: cross sectional study |journal=BMC Infect. Dis. |volume=15 |issue= |pages=547 |date=November 2015 |pmid=26612502 |pmc=4661959 |doi=10.1186/s12879-015-1290-4 |url=}}</ref>
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* Plasmodium
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* Worldwide
* More common in tropical and subtropical regions
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* Bitten by Anopheles mosquito
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" |Nl
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" |↓
| align="center" style="background:#F5F5F5;" |Nl
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" |–
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* Flu-like symptoms
* [[Headache]]
* [[Shivering]]
* [[Joint]] pain
* [[Vomiting]]
| align="center" style="background:#F5F5F5;" |↑
| align="center" style="background:#F5F5F5;" |↓
| align="center" style="background:#F5F5F5;" |↑
| align="center" style="background:#F5F5F5;" |Nl
| align="center" style="background:#F5F5F5;" |↑
| align="center" style="background:#F5F5F5;" |Nl
| align="center" style="background:#F5F5F5;" |↑
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* [[Hemoglobinuria]]
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| align="center" style="background:#F5F5F5;" |NA
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|-
! align="center" style="background:#DCDCDC;" |[[Schistosomiasis]]<ref name="pmid25434143">{{cite journal |vauthors=Pan J, Liu L, Yan YH, Shao ZW, Li Q, Zhou RH |title=[Application of health education path in advanced schistosomiasis patients with splenomegaly in perioperative period] |language=Chinese |journal=Zhongguo Xue Xi Chong Bing Fang Zhi Za Zhi |volume=26 |issue=4 |pages=425–7, 430 |date=August 2014 |pmid=25434143 |doi= |url=}}</ref>
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|-
! align="center" style="background:#DCDCDC;" |[[Toxoplasmosis]]<ref name="pmid25210646">{{cite journal |vauthors=Oz HS |title=Novel Synergistic Protective Efficacy of Atovaquone and Diclazuril on Fetal-Maternal Toxoplasmosis |journal=Int J Clin Med |volume=5 |issue=15 |pages=921–932 |date=August 2014 |pmid=25210646 |pmc=4157831 |doi= |url=}}</ref>
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|-
|-
! align="center" style="background:#DCDCDC;" |[[Visceral leishmaniasis|Kala-azar]]<ref name="pmid24850963">{{cite journal |vauthors=Sayyahfar S, Ansari S, Mohebali M, Behnam B |title=Visceral leishmaniasis without fever in an 11-month-old infant: a rare clinical feature of Kala-azar |journal=Korean J. Parasitol. |volume=52 |issue=2 |pages=189–91 |date=April 2014 |pmid=24850963 |pmc=4028457 |doi=10.3347/kjp.2014.52.2.189 |url=}}</ref>
! align="center" style="background:#DCDCDC;" |[[Visceral leishmaniasis|Kala-azar]]<ref name="pmid24850963">{{cite journal |vauthors=Sayyahfar S, Ansari S, Mohebali M, Behnam B |title=Visceral leishmaniasis without fever in an 11-month-old infant: a rare clinical feature of Kala-azar |journal=Korean J. Parasitol. |volume=52 |issue=2 |pages=189–91 |date=April 2014 |pmid=24850963 |pmc=4028457 |doi=10.3347/kjp.2014.52.2.189 |url=}}</ref>
| align="center" style="background:#F5F5F5;" |[[Visceral leishmaniasis]]
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|-
! colspan="2" align="center" style="background:#DCDCDC;" |[[Endocarditis|Infective endocarditis]]<ref name="pmid25352503">{{cite journal |vauthors=Francischetto O, Silva LA, Senna KM, Vasques MR, Barbosa GF, Weksler C, Ramos RG, Golebiovski WF, Lamas Cda C |title=Healthcare-associated infective endocarditis: a case series in a referral hospital from 2006 to 2011 |journal=Arq. Bras. Cardiol. |volume=103 |issue=4 |pages=292–8 |date=October 2014 |pmid=25352503 |pmc=4206359 |doi= |url=}}</ref>
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|-
! colspan="2" align="center" style="background:#DCDCDC;" |[[Fungus|Fungal]]<ref name="pmid23118473">{{cite journal |vauthors=Balakrishnan N, Jawanda JS, Miller MB, Breitschwerdt EB |title=Bartonella henselae infection in a man with hypergammaglobulinaemia, splenomegaly and polyclonal plasmacytosis |journal=J. Med. Microbiol. |volume=62 |issue=Pt 2 |pages=338–41 |date=February 2013 |pmid=23118473 |doi=10.1099/jmm.0.052134-0 |url=}}</ref>
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* [[Leishmaniasis|Leishmania]]
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* Any age
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* Bitten by sandflies
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" |↓
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" |↓
| align="center" style="background:#F5F5F5;" |Nl
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
* Asymptomatic
* Tender [[spleen]]
* [[Hepatomegaly]]
| align="center" style="background:#F5F5F5;" |↓
| align="center" style="background:#F5F5F5;" |↓
| align="center" style="background:#F5F5F5;" |↓
| align="center" style="background:#F5F5F5;" |Nl
| align="center" style="background:#F5F5F5;" |↑
| align="center" style="background:#F5F5F5;" |↑
| align="center" style="background:#F5F5F5;" |↑
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| align="center" style="background:#F5F5F5;" |
* [[Hemoglobinuria]]
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* Visualization of the characteristic amastigote in smears or tissue
| align="center" style="background:#F5F5F5;" |NA
| align="center" style="background:#F5F5F5;" |Culture
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| align="center" style="background:#F5F5F5;" |
* Could be fatal
|-
|-
! colspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Disease
! colspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Disease
Line 948: Line 1,016:
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Fever
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Fever
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Fatigue
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Fatigue
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Weight loss
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Weight
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Abdominal pain
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Abdominal pain
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Bleeding
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Bleeding
Line 974: Line 1,042:
* [[Immunity (medical)|Immune]] mediated
* [[Immunity (medical)|Immune]] mediated
* Unknown
* Unknown
| align="center" style="background:#F5F5F5;" |[[Autoimmune disease]], more in young African American women
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* [[Autoimmune disease]]
* More common in young African American women
| align="left" style="background:#F5F5F5;" |
| align="left" style="background:#F5F5F5;" |
* Positive family history
* Positive family history
Line 1,011: Line 1,081:
| align="left" style="background:#F5F5F5;" |
| align="left" style="background:#F5F5F5;" |
* Immune complex [[hypersensitivity]] (type III) to certain medications
* Immune complex [[hypersensitivity]] (type III) to certain medications
| align="center" style="background:#F5F5F5;" |Any
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* Any age
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* Consumption of certain medications
* Consumption of certain medications
Line 1,053: Line 1,124:
| align="left" style="background:#F5F5F5;" |
| align="left" style="background:#F5F5F5;" |
* Immune mediated [[Bone marrow suppression|bone marrow failure]]
* Immune mediated [[Bone marrow suppression|bone marrow failure]]
| align="center" style="background:#F5F5F5;" |More in young females
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* More common in young females
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| align="left" style="background:#F5F5F5;" |
* Positive family history
* Positive family history
Line 1,090: Line 1,162:
| align="left" style="background:#F5F5F5;" |
| align="left" style="background:#F5F5F5;" |
* Immune mediated [[Bone marrow suppression|bone marrow failure]]
* Immune mediated [[Bone marrow suppression|bone marrow failure]]
| align="center" style="background:#F5F5F5;" |Rare [[autoimmune disease]], more in females 50-70 years old
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* Rare [[autoimmune disease]]  
* More common in females 50-70 years old
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| align="left" style="background:#F5F5F5;" |
* History of [[rheumatoid arthritis]]
* History of [[rheumatoid arthritis]]
Line 1,123: Line 1,197:
* [[Infection|Infections]]
* [[Infection|Infections]]
|-
|-
! rowspan="7" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Infiltrative
! rowspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Infiltrative
! colspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Disease
! colspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Disease
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Etiology
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Etiology
Line 1,154: Line 1,228:
| align="left" style="background:#F5F5F5;" |
| align="left" style="background:#F5F5F5;" |
* Accumulatio<nowiki/>n of [[glucocerebroside]]
* Accumulatio<nowiki/>n of [[glucocerebroside]]
| align="center" style="background:#F5F5F5;" |[[Autosomal recessive]] hereditary deficiency of the enzyme [[glucocerebrosidase]], more in Ashkenazi Jews
| align="center" style="background:#F5F5F5;" |
* [[Autosomal recessive]] hereditary deficiency of the enzyme [[glucocerebrosidase]]
* More in Ashkenazi Jews
| align="left" style="background:#F5F5F5;" |
| align="left" style="background:#F5F5F5;" |
* Positive family history
* Positive family history
Line 1,195: Line 1,271:
* Deficiency in the activity of the lysosomal enzyme acid [[sphingomyelinase]]
* Deficiency in the activity of the lysosomal enzyme acid [[sphingomyelinase]]
* Accumulation of [[sphingomyelin]]
* Accumulation of [[sphingomyelin]]
| align="center" style="background:#F5F5F5;" |[[Autosomal recessive]] [[lysosomal storage disease]], more in Ashkenazi Jews
| align="center" style="background:#F5F5F5;" |
* [[Autosomal recessive]] [[lysosomal storage disease]]
* More common in Ashkenazi Jews
| align="left" style="background:#F5F5F5;" |
| align="left" style="background:#F5F5F5;" |
* Positive family history
* Positive family history
Line 1,235: Line 1,313:
* [[Splenic rupture]]
* [[Splenic rupture]]
* [[Coronary arteries|Coronary artery]] or [[valvular heart disease]]
* [[Coronary arteries|Coronary artery]] or [[valvular heart disease]]
|-
! colspan="2" align="center" style="background:#DCDCDC;" |[[Amyloidosis]]<ref name="pmid26230754">{{cite journal |vauthors=Czeyda-Pommersheim F, Hwang M, Chen SS, Strollo D, Fuhrman C, Bhalla S |title=Amyloidosis: Modern Cross-sectional Imaging |journal=Radiographics |volume=35 |issue=5 |pages=1381–92 |date=2015 |pmid=26230754 |doi=10.1148/rg.2015140179 |url=}}</ref>
| align="left" style="background:#F5F5F5;" |
* [[Protein]] misfolding
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|-
|-
! colspan="2" align="center" style="background:#DCDCDC;" |[[Langerhans cell histiocytosis]]<ref name="pmid25281259">{{cite journal |vauthors=DiCaprio MR, Roberts TT |title=Diagnosis and management of langerhans cell histiocytosis |journal=J Am Acad Orthop Surg |volume=22 |issue=10 |pages=643–52 |date=October 2014 |pmid=25281259 |doi=10.5435/JAAOS-22-10-643 |url=}}</ref>
! colspan="2" align="center" style="background:#DCDCDC;" |[[Langerhans cell histiocytosis]]<ref name="pmid25281259">{{cite journal |vauthors=DiCaprio MR, Roberts TT |title=Diagnosis and management of langerhans cell histiocytosis |journal=J Am Acad Orthop Surg |volume=22 |issue=10 |pages=643–52 |date=October 2014 |pmid=25281259 |doi=10.5435/JAAOS-22-10-643 |url=}}</ref>
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
* Clonal proliferation of Langerhans cells
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* Any age
* More common in children between 5-10 years old
* Boys>girls
| align="center" style="background:#F5F5F5;" | -
| align="center" style="background:#F5F5F5;" | -
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" |↓
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | -
| align="center" style="background:#F5F5F5;" |Nl
| align="center" style="background:#F5F5F5;" |Nl
| align="center" style="background:#F5F5F5;" | +
| align="center" style="background:#F5F5F5;" | -
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* Painful bone swelling
* Scaly erythematous lesions
* [[Lymphadenopathy]]
* [[Cough]]
* [[Dyspnea]]
| align="center" style="background:#F5F5F5;" |↓
| align="center" style="background:#F5F5F5;" |↓
| align="center" style="background:#F5F5F5;" |↓
| align="center" style="background:#F5F5F5;" |Nl
| align="center" style="background:#F5F5F5;" |↑
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| align="center" style="background:#F5F5F5;" |↑
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* [[Proteinuria]]
* [[Hematuria]]
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* Birbeck [[granules]] on electron microscopy
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* Osteolytic lesions on imaging
* Lung nodules on imaging
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* [[Diabetes insipidus]]
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! colspan="2" align="center" style="background:#DCDCDC;" |[[Hemophagocytic lymphohistiocytosis]]<ref name="pmid26461149">{{cite journal |vauthors=Filipovich AH, Chandrakasan S |title=Pathogenesis of Hemophagocytic Lymphohistiocytosis |journal=Hematol. Oncol. Clin. North Am. |volume=29 |issue=5 |pages=895–902 |date=October 2015 |pmid=26461149 |doi=10.1016/j.hoc.2015.06.007 |url=}}</ref>
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! colspan="2" align="center" style="background:#DCDCDC;" |[[Rosai Dorfman disease|Rosai-Dorfman disease]]<ref name="pmid23818241">{{cite journal |vauthors=Hashimoto K, Kariya S, Onoda T, Ooue T, Yamashita Y, Naka K, Okano M, Nishizaki K |title=Rosai-Dorfman disease with extranodal involvement |journal=Laryngoscope |volume=124 |issue=3 |pages=701–4 |date=March 2014 |pmid=23818241 |doi=10.1002/lary.24290 |url=}}</ref>
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! rowspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Hematologic (hypersplenic) states
! colspan="2" align="center" style="background:#DCDCDC;" |[[Hemolytic anemia]]<ref name="pmid26447931">{{cite journal |vauthors=Hill QA |title=Autoimmune hemolytic anemia |journal=Hematology |volume=20 |issue=9 |pages=553–4 |date=October 2015 |pmid=26447931 |doi=10.1179/1024533215Z.000000000401 |url=}}</ref>
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|-
! colspan="2" align="center" style="background:#DCDCDC;" |[[Sickle-cell disease|Sickle cell disease]]<ref name="pmid25390134">{{cite journal |vauthors=Gravitz L, Pincock S |title=Sickle-cell disease |journal=Nature |volume=515 |issue=7526 |pages=S1 |date=November 2014 |pmid=25390134 |doi=10.1038/515S1a |url=}}</ref>
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! colspan="2" align="center" style="background:#DCDCDC;" |[[Granulocyte colony-stimulating factor]]<ref name="pmid23419039">{{cite journal |vauthors=Abraham I, Tharmarajah S, MacDonald K |title=Clinical safety of biosimilar recombinant human granulocyte colony-stimulating factors |journal=Expert Opin Drug Saf |volume=12 |issue=2 |pages=235–46 |date=March 2013 |pmid=23419039 |doi=10.1517/14740338.2013.770472 |url=}}</ref>
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! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Category
! colspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Disease
! colspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Disease
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Etiology
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Etiology
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! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Fever
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Fever
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Fatigue
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Fatigue
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Weight loss
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Weight
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Abdominal pain
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Abdominal pain
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Bleeding
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Bleeding
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! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Associated findings
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Associated findings
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==Diagnosis==
==Treatment==
If the splenomegaly underlies hypersplenism, a [[splenectomy]] is indicated and it will correct the problem. After [[splenectomy]], patients have an increased risk for infectious diseases. After [[splenectomy]], patients should be [[vaccine|vaccinated]] against ''[[Haemophilus influenzae]]'' and ''[[Streptococcus pneumoniae]]''. They should receive annual [[influenza vaccination]]. Long-term [[prophylaxis|prophylactic]] [[antibiotic]] should be given.


==References==
==References==

Latest revision as of 18:38, 3 February 2019


For the patient information page for this topic, click here

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sadaf Sharfaei M.D.[2], Gichoya Judy Wawira [3],

Synonyms and keywords: Spleen enlargement; enlarged spleen; spleen swelling

Overview

Pathophysiology

Causes

The causes of splenomegaly vary widely and range from increased splenic function (such as hemoglobinopathies), splenic congestion due to abnormal blood flow (such as venous obstruction), and splenic infiltration (such as storage disorders and malignancies).

Causes by Pathogenesis

Mechanism Pathogenesis Example
Increased function Removal of defective RBCs
Immune hyperplasia Response to infection (viral, bacterial, fungal, parasitic)
Disordered immunoregulation
Drug reactions
Extramedullary hematopoiesis
Abnormal blood flow Organ Failure
Vascular
Infections
Infiltration Metabolic diseases
Benign and malignant infiltrations

Differentiating Splenomegaly from Other Diseases

Category Disease Etiology Clinical manifestations Para−clinical findings Gold standard Associated findings
Demography History Symptoms Signs Lab Findings Imaging
Fever Fatigue Weight Abdominal pain Bleeding BP JVP Jaundice Ascites Other CBC Iron LFT PT/PTT BUN/Cr UA Histopathology
WBC Hb Plt
Congestive Cirrhosis[1] Any age, more common in elderly + ↑↓ + + Nl + + Nl Liver biopsy
Heart failure[2] Elderly + ↑↓ ± + Nl Nl NA Echocardiography
Thrombosis of portal, hepatic, or splenic veins[3] Any age + + + + Nl ± + Nl NA Doppler ultrasonography
Malignancy Lymphoma[4] Any age, most common malignant splenic tumor + + + + Nl Nl + High ferritin Nl Lymph node biopsy
Leukemia[5] Elderly, male>female + + + + Nl Nl ± + High ferritin Nl
  • Leukemic blasts
  • Leukoerythroblastic features
  • Giant platelets
NA Bone marrow examination + clinical manifestation
Polycythemia Vera[6] Mean age >60 years old
  • Positive family history
+ Nl + Nl Nl Nl to ↑ Nl to ↑ High ferritin Nl Nl Nl Nl
  • Elevated normochromic, normocytic RBCs
  • Thrombocytosis
  • Rarely immature cells
  • Leukoerythroblastic picture
NA WHO criteria for PV
Disease Etiology Demography History Fever Fatigue Weight loss Abdominal pain Bleeding BP JVP Jaundice Ascites Other WBC Hb Plt Iron LFT PT/PTT BUN/Cr UA Histopathology Imaging Gold standard Associated findings
Multiple myeloma[7] Any age, more common in adults + + + + Nl Nl + High ferritin Nl
  • Blast cells
Bone marrow examination
Essential thrombocythemia[8]
  • Acquired mutation of JAK2, CALR, or MPL
Mean age >60 years old, female > male ± + Nl + + Nl Nl ↑↑ Nl Nl Nl Nl Nl Bone marrow biopsy
Primary myelofibrosis[9] Mean age >60 years old, male> female + Nl + + Nl Nl + ↑/↓ Low iron Nl Nl Bone marrow biopsy
Primary splenic tumors[10] Very rare
  • Positive family history
+ + + Nl Nl Low iron, low ferritin
  • Different histopathologic features depends on the type of tumor
Biopsy
Metastatic solid tumors[11] Any age, more in adults + + + + Nl ± ± Low iron, high ferritin
  • Blast cells
Biopsy
Disease Etiology Demography History Fever Fatigue Weight Abdominal pain Bleeding BP JVP Jaundice Ascites Other WBC Hb Plt Iron LFT PT/PTT BUN/Cr UA Histopathology Imaging Gold standard Associated findings
Infection Viral Hepatitis[12]
  • Any age
  • High risk behaviors
  • Close contact
+ + + + Nl Nl + + Nl NA Clinical manifestation + lab tests
Infectious mononucleosis[13]
  • More common in children and young adults
  • Close contact
+ + Nl + Nl Nl + Nl Nl Nl Nl Nl NA NA Clinical manifestation + heterophile antibody test
Cytomegalovirus[14]
  • More common in:
    • Immunocompromised patients
    • During pregnancy
  • Close contact
+ + Nl + Nl Nl + Nl Nl Nl Nl Nl NA NA ELISA
Bacterial Salmonella[15]
  • Any age
  • Eating contaminated meat, eggs, or milk
+ Nl + Nl
  • Diarrhea
  • Abdominal cramps
  • Vomiting
  • Dehydration
Nl Nl Nl Nl NA NA Stool test
  • Typhoid fever
  • Reactive arthritis
  • Irritable bowel syndrome
Brucella[16]
  • Brucella
  • Any age
  • Ingesting contaminated food such as unpasteurized milk products
  • Direct contact with an infected animal
  • Inhalation of aerosols
+ + Nl + Nl +
  • Headache
  • Vomiting
  • Diarrhea
  • Constipation
  • Arthralgia
  • Night sweats
  • Anorexia
  • Foul-smelling perspiration
Nl Nl Nl Nl NA NA Blood culture
  • Arthritis
  • Epididymo-orchitis
  • Spondylitis
  • Neurobrucellosis
  • Liver abscess formation
  • Endocarditis
Tuberculosis[17]
  • Mycobacterium tuberculosis
  • Any age
  • More common in developing countries and among immunocompromised patients
  • Close contact
  • HIV
+ + + Nl +
  • Chronic cough with blood-containing sputum
  • Night sweats
  • Anorexia
  • Chest pain
Nl Nl
  • Acid-fast bacillus
  • Cavity on chest x ray
Identifying M. tuberculosis in a clinical sample
  • Tuberculous meningitis
  • Urogenital tuberculosis
  • Pott disease
  • Miliary tuberculosis
Parasitic Malaria[18]
  • Plasmodium
  • Worldwide
  • More common in tropical and subtropical regions
  • Bitten by Anopheles mosquito
+ + Nl + + Nl + Nl Nl NA
Kala-azar[19]
  • Any age
  • Bitten by sandflies
+ + + + Nl + + Nl
  • Visualization of the characteristic amastigote in smears or tissue
NA Culture
  • Could be fatal
Disease Etiology Demography History Fever Fatigue Weight Abdominal pain Bleeding BP JVP Jaundice Ascites Other WBC Hb Plt Iron LFT PT/PTT BUN/Cr UA Histopathology Imaging Gold standard Associated findings
Inflammation Sarcoidosis[20]
  • Positive family history
+ + + + Nl Nl Nl Nl Nl Nl Nl NA Diagnosis of exclusion
Serum sickness[21]
  • Any age
  • Consumption of certain medications
+ + Nl + Nl ↓ or ↑

Eosinophilia

Nl Nl Nl NA Clinical manifestation + recent medication consumption
Systemic lupus erythematosus[22]
  • More common in young females
  • Positive family history
+ + + + Nl to ↓ Nl + + Clinical findings + laboratory studies
  • Multi organ damage
Felty syndrome[23] + + + + Nl to ↓ Nl + + Nl Nl Nl Nl Nl Clinical findings + laboratory studies
Infiltrative Disease Etiology Demography History Fever Fatigue Weight Abdominal pain Bleeding BP JVP Jaundice Ascites Other WBC Hb Plt Iron LFT PT/PTT BUN/Cr UA Histopathology Imaging Gold standard Associated findings
Gaucher disease[24]
  • Positive family history
- + + + Nl to ↓ Nl + + Nl Nl NA Enzyme testing
Niemann-Pick disease[25]
  • Positive family history
- + + + Nl to ↓ Nl + + Nl NA Genetic testing
Langerhans cell histiocytosis[26]
  • Clonal proliferation of Langerhans cells
  • Any age
  • More common in children between 5-10 years old
  • Boys>girls
- - + + - Nl Nl + - Nl
  • Osteolytic lesions on imaging
  • Lung nodules on imaging
Tissue biopsy
Category Disease Etiology Demography History Fever Fatigue Weight Abdominal pain Bleeding BP JVP Jaundice Ascites Other WBC Hb Plt Iron LFT PT/PTT BUN/Cr UA Histopathology Imaging Gold standard Associated findings

Diagnosis

Treatment

If the splenomegaly underlies hypersplenism, a splenectomy is indicated and it will correct the problem. After splenectomy, 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 vaccination. Long-term prophylactic antibiotic should be given.

References

  1. Wu Z, Zhou J, Pankaj P, Peng B (December 2012). "Laparoscopic and open splenectomy for splenomegaly secondary to liver cirrhosis: an evaluation of immunity". Surg Endosc. 26 (12): 3557–64. doi:10.1007/s00464-012-2366-5. PMID 22710653.
  2. Gedela M, Khan M, Jonsson O (September 2015). "Heart Failure". S D Med. 68 (9): 403–5, 407–9. PMID 26489162.
  3. Ferri PM, Ferreira AR, Fagundes ED, Liu SM, Roquete ML, Penna FJ (2012). "Portal vein thrombosis in children and adolescents: 20 years experience of a pediatric hepatology reference center". Arq Gastroenterol. 49 (1): 69–76. PMID 22481689.
  4. Ishibashi N, Maebayashi T, Aizawa T, Sakaguchi M, Abe O, Saito T, Tanaka Y (May 2015). "Myelosuppression toxicity of palliative splenic irradiation in myelofibrosis and malignant lymphoma". Hematology. 20 (4): 203–7. doi:10.1179/1607845414Y.0000000192. PMID 25131182.
  5. Quest GR, Johnston JB (December 2015). "Clinical features and diagnosis of hairy cell leukemia". Best Pract Res Clin Haematol. 28 (4): 180–92. doi:10.1016/j.beha.2015.10.017. PMID 26614896.
  6. Chou YS, Gau JP, Yu YB, Pai JT, Hsiao LT, Liu JH, Hong YC, Liu CY, Yang CF, Chen PM, Chiou TJ, Tzeng CH (March 2013). "Leukocytosis in polycythemia vera and splenomegaly in essential thrombocythemia are independent risk factors for hemorrhage". Eur. J. Haematol. 90 (3): 228–36. doi:10.1111/ejh.12064. PMID 23281576.
  7. Grieco A, Manna R, Mancini R, Gambassi G (April 1988). "Massive hepatomegaly following splenectomy for myeloid metaplasia". Am. J. Med. 84 (4): 797. PMID 3400674.
  8. Tefferi A, Barbui T (February 2015). "Polycythemia vera and essential thrombocythemia: 2015 update on diagnosis, risk-stratification and management". Am. J. Hematol. 90 (2): 162–73. doi:10.1002/ajh.23895. PMID 25611051.
  9. Cervantes F, Martinez-Trillos A (May 2013). "Myelofibrosis: an update on current pharmacotherapy and future directions". Expert Opin Pharmacother. 14 (7): 873–84. doi:10.1517/14656566.2013.783019. PMID 23514013.
  10. Adachi K, Ui M, Nojima H, Takada Y, Enatsu K (August 2011). "Isolated splenic peliosis presenting with giant splenomegaly and severe coagulopathy". Am. J. Surg. 202 (2): e17–9. doi:10.1016/j.amjsurg.2010.10.002. PMID 21810495.
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