Splenomegaly

The spleen normally lies along the long axis of the 10th rib. Its lower pole extends forward as far as the midaxillary line.

Causes of splenomegaly include:

• Haematological 
• Lymphoma 
• Polycythaemia vera 
• Leukaemias, especially CML 
• Myelofibrosis
• Haemolytic conditions 
• Thalassemia 
• Haemoglobinopathies
• Hereditary spherocytosis
• Infection 
• Tuberculosis 
• Malaria
• Leishmaniasis 
• Schistosomiasis
• Mycobacterium avium complex
• Endocarditis
• Infectious mononucleosis 
• Autoimmune 
• SLE 
• Felty’s syndrome 
• Splenomegaly of portal hypertension 
• Liver cirrhosis
• Hepatic and splenic vein obstructions 
• Other
• Gaucher’s disease 
• Sarcoidosis
• Congestive cardiac failure 

Diseases in which splenomegaly if present is most likely to be massive are:

• Myelofibrosis 
• Lymphoma 
• Schistosomiasis
• Gaucher’s disease

However, the commonest cause of massive splenomegaly in a large study in America was chronic liver disease. 

References

Howells, L. The differential diagnosis in splenomegaly. Postgrad Med J. 1937. 13(141): 241-246.

O’Reilly, R. Splenomegaly in 2,505 patients at a large university medical center from 1913 ro 1995. 1963 to 1995: 449 patients. West J Med. 1998; 169(2): 88-97. 

Yang, J., Rickman, L. and Bosser, S. The clinical diagnosis of splenomegaly. West J Med. 1991; 155(1): 47-52.