Splenic enlargement in congestive heart failure and active rheumatic infection.

It is generally stated that the spleen rarely if ever enlarges sufficiently to become palpable in uncomplicated congestive heart failure. Rolleston (1908) and Held (1919) both concluded that a palpable spleen in congestive failure was due to some complication. Talley and Lindsey (1924) in 198 cases ofcongestive failure in adults found 3 with palpable spleens. Fishberg (1940) in discussing the question concludes that the spleen may enlarge at the onset of failure, but that, later, it decreases in size owing to fibrosis and to contraction, which contributes to increasing the circulating blood volume, so that in chronic failure a condition of " cyanotic atrophy " of the spleen is found. Fishberg mentions the following causes of a palpable spleen in heart failure:(1) Active infection, e.g. rheumatic carditis. (2) Cardiac cirrhosis of the liver from chronic right-sided heart failure. (3) Mediastino-pericarditis. (4) Large left pleural effusion displacing the spleen downwards.