Splenomegaly
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Splenomegaly | |
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CT scan in a patient with chronic lymphocytic leukemia, showing splenomegaly. Yellow arrows point at the spleen. | |
Specialty | General surgery |
Splenomegaly is an enlargement of the
Definition
The standard system for classifying splenomegaly on radiography is:[3][4]
- Normal (not splenomegaly): the largest dimension is less than 11 cm
- Moderate splenomegaly: the largest dimension is between 11 and 20 cm
- Severe splenomegaly: the largest dimension is greater than 20 cm
Also, a
Height | Spleen length | |
---|---|---|
Women | Men | |
155 – 159 cm | 6.4 – 12 cm | |
160 – 164 cm | 7.4 - 12.2 cm | 8.9 - 11.3 cm |
165 – 169 cm | 7.5 – 11.9 cm | 8.5 – 12.5 cm |
170 – 174 cm | 8.3 – 13.0 cm | 8.6 – 13.1 cm |
175 – 179 cm | 8.1 – 12.3 cm | 8.6 – 13.4 cm |
180 – 184 cm | 9.3 – 13.4 cm | |
185 – 189 cm | 9.3 – 13.6 cm | |
190 – 194 cm | 9.7 – 14.3 cm | |
195 – 199 cm | 10.2 – 14.4 cm |
Age | Cutoff[7] |
---|---|
3 months | 6.0 cm |
6 months | 6.5 cm |
12 months | 7.0 cm |
2 years | 8.0 cm |
4 years | 9.0 |
6 years | 9.5 cm |
8 years | 10.0 cm |
10 years | 11.0 cm |
12 years | 11.5 cm |
15 years |
|
For children, the cutoffs for splenomegaly are given in this table, when measuring the greatest length of the spleen between its dome and its tip, in the coronal plane through its hilum while breathing quietly.[7]
At autopsy, splenomegaly can be defined as a spleen weight above the upper limit of the standard reference range of 230 g (8.1 oz).[8][9]
Splenomegaly refers strictly to spleen enlargement, and is distinct from hypersplenism, which connotes overactive function by a spleen of any size. Splenomegaly and hypersplenism should not be confused. Each may be found separately, or they may coexist. Clinically, if a spleen is palpable (felt via external examination), it means it is enlarged as it has to undergo at least twofold enlargement to become palpable. However, the tip of the spleen may be palpable in a newborn baby up to three months of age.[10]
Signs and symptoms
In cases of infectious mononucleosis splenomegaly is a common symptom and health care providers may consider using abdominal ultrasonography to get insight into a person's condition.[12] However, because spleen size varies greatly, ultrasonography is not a valid technique for assessing spleen enlargement and should not be used in typical circumstances or to make routine decisions about fitness for playing sports.[12]
Causes
The most common causes of splenomegaly in developed countries are
The possible causes of moderate splenomegaly (spleen <1000 g) are many, and include:
Increased function | Abnormal blood flow | Infiltration |
---|---|---|
Removal of defective RBCs
Immune hyperplasia Response to infection (viral, bacterial, fungal, parasitic)
Disordered immunoregulation
Extramedullary hematopoiesis
|
Organ Failure
Vascular
Infections
|
Metabolic diseases
Benign and malignant "infiltrations"
|
The causes of massive splenomegaly (spleen >1000 g) are
Pathophysiology
Splenomegaly can be classified based on its pathophysiologic mechanism:
- Congestive, by pooled blood (e.g., portal hypertension)
- Infiltrative, by invasion by cells foreign to the splenic environment (e.g., lipid storage diseases)
- Immune, by an increase in immunologic activity and subsequent hyperplasia (e.g., endocarditis, sarcoidosis, rheumatoid arthritis)
- ).
Diagnosis
Abdominal CT is the most accurate. The spleen needs to be 2–3 times larger than normal to be palpable below the costal margin in physical examination.
Treatment
If the splenomegaly underlies hypersplenism, a splenectomy is indicated and will correct the hypersplenism. However, the underlying cause of the hypersplenism will most likely remain; consequently, a thorough diagnostic workup is still indicated, as, leukemia, lymphoma and other serious disorders can cause hypersplenism and splenomegaly. After splenectomy, however, patients have an increased risk for infectious diseases.
Patients undergoing splenectomy should be
As an adaptation
An enlarged spleen may be an inherited, adaptive trait selected in populations that need extra oxygen carry capacity such as deep sea divers.[21][22]
See also
References
- ^ PMID 28613657, retrieved 2019-02-26
- PMID 20959010.
- ^ Neetu Radhakrishnan. "Splenomegaly". Medscape. Retrieved February 16, 2018. Updated Apr. 2012 (referring the classification system to Poulin et al.
- ISBN 9783540671367.
- PMID 22096219.
- PMID 26509293.
- ^ PMID 2048509.
- S2CID 32174574.
- S2CID 25319215.
- PMID 30138410.
- PMID 8411607. Ovid full text
- ^ ABIM Foundation, American Medical Society for Sports Medicine, retrieved 29 July 2014, which cites
- Putukian, M; O'Connor, FG; Stricker, P; McGrew, C; Hosey, RG; Gordon, SM; Kinderknecht, J; Kriss, V; Landry, G (Jul 2008). "Mononucleosis and athletic participation: an evidence-based subject review". Clinical Journal of Sport Medicine. 18 (4): 309–15. S2CID 23780443.
- Spielmann, AL; DeLong, DM; Kliewer, MA (Jan 2005). "Sonographic evaluation of spleen size in tall healthy athletes". AJR. American Journal of Roentgenology. 184 (1): 45–9. PMID 15615949.
- Putukian, M; O'Connor, FG; Stricker, P; McGrew, C; Hosey, RG; Gordon, SM; Kinderknecht, J; Kriss, V; Landry, G (Jul 2008). "Mononucleosis and athletic participation: an evidence-based subject review". Clinical Journal of Sport Medicine. 18 (4): 309–15.
- ISBN 0-7817-5641-3.
- ^
Durden LA (1995). "Bot Fly (Cuterebra fontinella fontinella) Parasitism of Cotton Mice (Peromyscus gossypinus) on St. Catherines Island, Georgia". The Journal of Parasitology. 81 (5): 787–790. PMID 7472877.
- PMID 14614691.
- PMID 9191748.
- ^ Neufeld EF, Muenzer J (1995). "The mucopolysaccharidoses". In Scriver CR, Beaudet AL, Sly WS, Valle D (eds.). The metabolic and molecular bases of inherited disease.7th ed. Vol. 2. McGraw-Hill, New York. pp. 2465–94.
- PMID 16999722.
- PMID 11547761.
- S2CID 29326931.
- ^ Rappaport, Lisa (19 April 2018). "Large spleen helps explain deep-diving skills of Southeast Asian 'sea nomads'". Reuters. Retrieved 20 April 2018.
- PMID 29677510.
External links
- Splenomegaly and hypersplenism at patient.info