Exam

Splenomegaly

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Splenomegaly, Spleen Enlargement

  • Signs
  1. Spleen exam: Right lateral decubitus position
    1. Best position to examine enlarged Spleen
    2. Note splenic size in cm below left costal margin
    3. Castell's Point percussion (best Negative Likelihood Ratio)
      1. Percuss point at mid-axillary line at last intercostal space
      2. Dull to percussion in cases of Splenomegaly (if hollow sound then rules-out diagnosis)
      3. Palpate below costal margin to confirm
  2. Lymphadenopathy
  • Labs
  1. Complete Blood Count
  2. Peripheral Smear
    1. Howell Jolly bodies (seen in Asplenism)
    2. Thrombocytopenia (seen in splenic hyperfunction)
  • Radiology
  1. Splenic Ultrasound
  2. Abdominal CT (evaluate splenic masses)
  3. Gallium Scan (suspected Lymphoma or infection)
  4. Technetium liver-Spleen scan (comorbid liver disease)
  • Evaluation
  1. Step 1: Confirm Splenomegaly
    1. Select imaging study (usually CT or Ultrasound)
  2. Step 2: Evaluate for hematologic or infectious cause
    1. Consider Complete Blood Count and Peripheral Smear
  3. Step 3: Evaluate for cardiovascular cause
    1. Consider Liver Function Tests and Echocardiogram
    2. Causes
      1. Liver disease with Portal Hypertension
      2. Congestive Heart Failure
      3. Subacute Bacterial Endocarditis
  4. Step 3: Evaluate for autoimmune causes
    1. Consider sedimentation rate, ANA, RF
    2. Causes
      1. Systemic Lupus Erythematosus
      2. Rheumatoid Arthritis
  5. Step 4: Evaluate Bone Marrow
    1. Consider Bone Marrow Biopsy with culture
  6. Step 5: Splenectomy if symptomatic
  • References
  1. Armitage in Goldman (2000) Cecil Medicine, p. 960-2
  2. Degowin (1987) Diagnostic Examination, p. 508-11
  3. Ferri (2004) Clinical Advisor, p. 1173 and p. 1330