splenomegaly-180319023541.pdf

spleen and

2. Splenomegaly
Definition
Classification
Etiology
Symptom
Diagnosis
References

4. Splenomegaly is defined by increased splenic
dimensions and volume.
Spleen diameters averaged over 13 cm and an area
above 45 cm
2
or weight above 400 g are considered
splenomegaly.

5. Normal Spleen Splenomegaly

6. Splenomegaly can be classify as;
Mild
Moderate
Massive

7. Mild Splenomegaly
Just palpable
(1-3) cm more than normal
spleen ≈14cm -16 cm
Spleen > 400 g < 1000 g
Mild Splenomegaly with Cirrhosis

8. Moderate Splenomegaly
Between costal margin & umbilicus
(4-8) cm more than normal spleen ≈17 cm –21 cm
Spleen > 400 g <1000 g
Splenic Area 45 cm
2
-65 cm
2

9. Massive Splenomegaly
Beyond umblicus, crosses mid line into pelvis
Spleen > 8cm than normal
Spleen > 1000g
Splenic area > 65 cm
2

11. Splenomegaly (SplenicLength) Age Group
>6.0 cm 3 months
>6.5 cm 6 months
>7.0 cm 12 months
>8.0 cm 2 years
>9.0cm 4 years
>9.5 cm 6 years
>10.0 cm 8 years
>11.0 cm 10 years
>11.5 cm 12 years
>12.0 cm 15 years

12. Splenomegaly due to exaggerated forms of normal splenic function;
-infections or inflammatory processes results from an increase in the
defense activities of the organ
-Removal of abnormal blood cells from the circulation is the usual
source of hyperplastic splenomegaly.
-Cirrhosis with portal hypertension, splenic vein occlusion or
congestive heart failure (CHF) causes congestive splenomegaly
-Infiltrative splenomegaly is the result of swelling of macrophages
with indigestible materials.

13. Cysts,
Hemangiomas,
Other malformations.
Several diseases can lead to splenomegaly; malaria,
anemias etc.

14. Associated symptoms or signs are typically related to the underlying
disorder.
Fever
Left Upper Quadrant pain (splenic infarct) (localize area of dead cell)
Fullness and early satiety
Feeling of heaviness in LUQ
Jaundice

15. Most practical and cost effective method
Perform a complete blood count (CBC) with differential, platelet count,
and peripheral blood smear
Computed Tomography
Magnetic Resonance Imaging,
Ultrasonography (High sensitivity & specificity, safe, noninvasive, quick, mobile, and
less costly)

16. Splenic Dimensions
Splenic Contour (Rounded Edge)
Dilated Splenic vein (> 9 mm)
-Homogenous, slightly hyperechoic, with mild-
to-low echogenicity compare to liver, a smooth contour.

17. Massive Splenomegaly
Mild irregular contour and inhomogeneous echo-structure with diffuse hyperechoic foci
suggesting small infarctions

18. Splenomegaly with Splenic Vein Dilation

20. If the spleen is minimally enlarged, may be followed with careful
and regular observation.
Patients with enlarged spleens are more likely to have splenic
rupture from blunt abdominal or low thoracic trauma.
Splenomegaly most likely result in splenectomy

21. SwaoopJ, O’ReilyRA. Splenomegaly at a University Hospital
compared to a nearby county hospital in 317 patients. Acta
Haematol1999;102:83-8.
IoanitescuS, Iliescu L, HarzaM, Ismail G, CopaciI. Ultrasound of
the spleen, EFSUMB Course Book;1-46. Published by EFSUMB,
2012.
RadhakrishnanN, Besa,C, E. Splenomegaly. Medscape. 2018
January 09;1-9
World Health Organisation, World Federation for Ultrasound in
Medicine and Biology: Manual of Diagnostic ultrasound; 2003