Massive Splenomegaly

Hospital Physician May 2008 31 Splenomegaly is a common finding in a wide spectrum of diseases. Massive splenomegaly, however, always indicates underlying pathology. Massive splenomegaly is usually defined as a spleen extending well into the left lower quadrant or pelvis or which has crossed the midline of the abdomen. Massive spleens weigh at least 500 to 1000 g. In a retrospective study evaluating splenomegaly in 2056 patients who presented to a large university medical center from 1913 to 1995, the most common disorders associated with splenomegaly were hematologic, infectious, hepatic, congestive, and inflammatory.1,2 Among patients with massive splenomegaly, 31% had a hematologic disorder, 17% had hepatic disease, and 8% had infectious disease. Chronic leukemias were associated most frequently with massive splenomegaly. The ability to detect splenomegaly on physical examination and knowing the differential diagnosis of massive splenomegaly can facilitate the timely diagnosis and treatment of the conditions associated with massive splenomegaly. This article reviews the physical examination of the spleen as well as methods of splenic imaging and discusses the causes of massive splenomegaly. Detailed management of the diseases that cause massive splenomegaly is beyond the scope of this discussion.