Exam
Splenomegaly
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Splenomegaly
, Spleen Enlargement
See Also
Asplenism
Hepatomegaly
Splenomegaly in Newborns
Causes
Infectious
Bacterial Infection
Subacute Bacterial Endocarditis
Brucellosis
Syphilis
Typhoid
Tuberculosis
Rocky Mountain Spotted Fever
Lyme Disease
Fungal Infection
Toxoplasmosis
Histoplasmosis
Parasitic Infection
Malaria
Leishmaniasis
Schistosomiasis
Viral infection
Epstein-Barr Virus Infection
(
Mononucleosis
)
Cytomegalovirus
HIV Infection
Viral Hepatitis
Malaria
Causes
Malignancy
Leukemia
Lymphoma
Melanoma
Sarcoma
Pancreatic Cancer
Myelofibrosis
Causes
Hematologic
Hemolytic Anemia
Thalassemia
major
Hereditary Spherocytosis
Sickle Cell Anemia
and other
Hemoglobinopathy
Megaloblastic Anemia
(e.g.
Pernicious Anemia
)
Polycythemia Vera
Causes
Miscellaneous
Liver
disease with secondary
Portal Hypertension
Congestive Heart Failure
Systemic Lupus Erythematosus
Rheumatoid Arthritis
(
Felty's Syndrome
)
Langerhan's Cell Histiocytosis
Gaucher's Disease
Hyperthyroidism
Sarcoidosis
Intravenous Drug Abuse
Signs
Lymphadenopathy
Spleen
exam: Right lateral decubitus position
Best position to examine enlarged
Spleen
Note splenic size in cm below left costal margin
Castell's Point percussion (best
Negative Likelihood Ratio
)
Percuss point at anterior axillary line at last intercostal space
Dull to percussion in cases of Splenomegaly (if hollow sound then rules-out diagnosis)
Palpate below costal margin to confirm
Labs
Complete Blood Count
Peripheral Smear
Howell Jolly bodies (seen in
Asplenism
)
Thrombocytopenia
(seen in splenic hyperfunction)
Radiology
Splenic
Ultrasound
Abdominal CT
(evaluate splenic masses)
Gallium Scan (suspected
Lymphoma
or infection)
Technetium liver-
Spleen
scan (comorbid liver disease)
Evaluation
Step 1: Confirm Splenomegaly
Select imaging study (usually CT or
Ultrasound
)
Step 2: Evaluate for hematologic or infectious cause
Consider
Complete Blood Count
and
Peripheral Smear
Step 3: Evaluate for cardiovascular cause
Consider
Liver Function Test
s and
Echocardiogram
Causes
Liver
disease with
Portal Hypertension
Congestive Heart Failure
Subacute Bacterial Endocarditis
Step 3: Evaluate for autoimmune causes
Consider sedimentation rate, ANA, RF
Causes
Systemic Lupus Erythematosus
Rheumatoid Arthritis
Step 4: Evaluate
Bone Marrow
Consider
Bone Marrow Biopsy
with culture
Step 5: Splenectomy if symptomatic
References
Armitage in Goldman (2000) Cecil Medicine, p. 960-2
Degowin (1987) Diagnostic Examination, p. 508-11
Ferri (2004) Clinical Advisor, p. 1173 and p. 1330
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