Splenomegaly Clinical Presentation
- Author: Neetu Radhakrishnan, MD; Chief Editor: Emmanuel C Besa, MD more...
The most common complaint in patients with splenomegaly is mild, vague, abdominal discomfort. Patients may also experience pain,which may be referred to the left shoulder. Increased abdominal girth is less common. Early satiety from gastric displacement occurs with massive splenomegaly. Associated symptoms or signs are typically related to the underlying disorder and may include the following:
Febrile illness (infectious)
Pallor, dyspnea, bruising, and/or petechiae (hemolytic process)
History of liver disease (congestive)
Weight loss, constitutional symptoms (neoplastic)
Pancreatitis (splenic vein thrombosis) 
Alcoholism, hepatitis (cirrhosis) [8, 9]
Family history should be reviewed to disclose relevant hereditary diseases, such as hemolytic anemias.
Splenic size is not a reliable guide to splenic function, and palpable spleens are not always abnormal. Patients with chronic obstructive pulmonary disease (COPD) and low diaphragms commonly have palpable spleens. In one study, 3% of healthy college freshmen had palpable spleens; an additional study showed that 5% of hospitalized patients with normal spleens based on scan results were thought to have palpable spleens by their physicians.
The physical examination should include palpation with the patient in the supine and right lateral decubitus position, with knees up and hips flexed. Apply light fingertip pressure as the patient slowly inspires. The use of the reverse Trendelenburg position may aid in bringing the spleen into contact with the examiner's fingers. This is especially helpful in patients with morbid obesity. The spleen moves with respiratory patterns and may be palpable only at the end of inspiration.
In extreme splenomegaly, shown in the image below, the lower splenic pole may extend into the pelvis or cross the abdominal midline. In these circumstances, palpation at the pelvic brim or the right upper quadrant may be necessary to delineate splenic size and location.
Percussion of the abdomen may disclose caudal displacement of the gastric bubble in massive splenomegaly. Additional signs that identify possible etiologies of splenomegaly include the following:
Signs of cirrhosis - Eg, asterixis, jaundice, telangiectasias, gynecomastia, caput medusa, and ascites
Heart murmur - Endocarditis or congestive failure
Scleral icterus - Spherocytosis or cirrhosis
Petechiae - Any other bleeding manifestation secondary to thrombocytopenia
Eichner ER. Splenic function: normal, too much and too little. Am J Med. 1979 Feb. 66(2):311-20. [Medline].
Poulin EC, Mamazza J, Schlachta CM. Splenic artery embolization before laparoscopic splenectomy. An update. Surg Endosc. 1998 Jun. 12(6):870-5. [Medline].
Ginzel AW, Kransdorf MJ, Peterson JJ, Garner HW, Murphey MD. Mass-like extramedullary hematopoiesis: imaging features. Skeletal Radiol. 2011 Nov 20. [Medline].
Arakawa Y, Shimada M, Utsunomiya T, Imura S, Morine Y, Ikemoto T, et al. Bevacizumab improves splenomegaly and decreases production of hyaluronic acid after L-OHP based chemotherapy. Anticancer Res. 2014 Apr. 34(4):1953-8. [Medline].
Koduri PR, Kovarik P. Acute splenic sequestration crisis in an adult with sickle beta-thalassemia. Ann Hematol. 2006 Sep. 85 (9):633-5. [Medline].
O'Reilly RA. Splenomegaly in 2,505 patients at a large university medical center from 1913 to 1995. 1963 to 1995: 449 patients. West J Med. 1998 Aug. 169 (2):88-97. [Medline].
Butler JR, Eckert GJ, Zyromski NJ, Leonardi MJ, Lillemoe KD, Howard TJ. Natural history of pancreatitis-induced splenic vein thrombosis: a systematic review and meta-analysis of its incidence and rate of gastrointestinal bleeding. HPB (Oxford). 2011 Dec. 13(12):839-45. [Medline]. [Full Text].
Zhu JH, Wang YD, Ye ZY, Zhao T, Zhu YW, Xie ZJ, et al. Laparoscopic versus open splenectomy for hypersplenism secondary to liver cirrhosis. Surg Laparosc Endosc Percutan Tech. 2009 Jun. 19(3):258-62. [Medline].
Anegawa G, Kawanaka H, Uehara H, Akahoshi T, Konishi K, Yoshida D, et al. Effect of laparoscopic splenectomy on portal hypertensive gastropathy in cirrhotic patients with portal hypertension. J Gastroenterol Hepatol. 2009 Sep. 24(9):1554-8. [Medline].
Motta I, Filocamo M, Poggiali E, Stroppiano M, Dragani A, et al. A multicentre observational study for early diagnosis of Gaucher disease in patients with Splenomegaly and/or Thrombocytopenia. Eur J Haematol. 2015 Jun 1. [Medline].
Olson AP, Trappey B, Wagner M, Newman M, Nixon LJ, Schnobrich D. Point-of-care ultrasonography improves the diagnosis of splenomegaly in hospitalized patients. Crit Ultrasound J. 2015 Dec. 7 (1):13. [Medline].
Bezerra AS, D''Ippolito G, Faintuch S, Szejnfeld J, Ahmed M. Determination of splenomegaly by CT: is there a place for a single measurement?. AJR Am J Roentgenol. 2005 May. 184(5):1510-3. [Medline]. [Full Text].
Goldstone J. Splenectomy for massive splenomegaly. Am J Surg. 1978 Mar. 135(3):385-8. [Medline].
Laws HL, Burlingame MW, Carpenter JT, Prchal JT, Conrad ME. Splenectomy for hematologic disease. Surg Gynecol Obstet. 1979 Oct. 149(4):509-12. [Medline].
Wang KX, Hu SY, Zhang GY, Chen B, Zhang HF. Hand-assisted laparoscopic splenectomy for splenomegaly: a comparative study with conventional laparoscopic splenectomy. Chin Med J (Engl). 2007 Jan 5. 120(1):41-5. [Medline]. [Full Text].
Subhasis RC, Rajiv C, Kumar SA, Kumar AV, Kumar PA. Surgical treatment of massive splenomegaly and severe hypersplenism secondary to extrahepatic portal venous obstruction in children. Surg Today. 2007. 37(1):19-23. [Medline].
Owusu-Ofori S, Remmington T. Splenectomy versus conservative management for acute sequestration crises in people with sickle cell disease. Cochrane Database Syst Rev. 2015 Sep 7. 9:CD003425. [Medline].
Lavrenkov K, Krepel-Volsky S, Levi I, Ariad S. Low dose palliative radiotherapy for splenomegaly in hematologic disorders. Leuk Lymphoma. 2012 Mar. 53(3):430-4. [Medline].
Bruns F, Bremer M, Dettmer A, Janssen S. Low-dose splenic irradiation in symptomatic congestive splenomegaly: report of five cases with literature data. Radiat Oncol. 2014 Mar 27. 9:86. [Medline]. [Full Text].
Mistry PK, Lukina E, Ben Turkia H, Amato D, Baris H, et al. Effect of oral eliglustat on splenomegaly in patients with Gaucher disease type 1: the ENGAGE randomized clinical trial. JAMA. 2015 Feb 17. 313 (7):695-706. [Medline].
Kawanaka H, Akahoshi T, Kinjo N, et al. Technical standardization of laparoscopic splenectomy harmonized with hand-assisted laparoscopic surgery for patients with liver cirrhosis and hypersplenism. J Hepatobiliary Pancreat Surg. 2009. 16(6):749-57. [Medline].
Xu WL, Li SL, Wang Y, Shi BJ, Li M, Li YC, et al. Laparoscopic splenectomy: color Doppler flow imaging for preoperative evaluation. Chin Med J (Engl). 2009 May 20. 122(10):1203-8. [Medline].
Shaw JH, Print CG. Postsplenectomy sepsis. Br J Surg. 1989 Oct. 76(10):1074-81. [Medline].