Splenomegaly refers to an enlarged spleen, which may occur in up to 5% of normal adults. Although it is not a diagnostic sign by itself, it often indicates infection, trauma, hepatic, autoimmune, neoplastic, or hematologic disorders. Because the spleen functions as the body’s largest lymphoid organ, any process causing lymphadenopathy may trigger splenic enlargement.

Pathophysiology

• Reactive hyperplasia: Response to infection or inflammation.

• Neoplastic infiltration: Proliferation of malignant cells within the spleen.

• Extramedullary hematopoiesis: Compensation for inadequate bone marrow function.

• Increased blood cell destruction: Seen in hemolytic anemias.

• Vascular congestion: Often secondary to portal hypertension.

Examination Tips

How to Palpate for Splenomegaly

1. Patient position: Supine; stand on the patient’s right side.

2. Hand placement: Left hand under the left costovertebral angle, gently pushing the spleen forward; right hand under the left costal margin.

3. Technique: Have the patient inhale deeply and exhale. During exhalation, move your right hand along the rib margin to feel the spleen’s edge.

4. Grading:

   • Slight: ½–1½″ (1–4 cm) below costal margin

   • Moderate: 1½–3″ (4–8 cm) below costal margin

   • Great: ≥3″ (≥8 cm) below costal margin

5. Alternate position: Right lateral decubitus with hips/knees slightly flexed; repeat palpation.

Caution: Avoid palpation if abdominal or thoracic trauma is suspected, as this may precipitate splenic rupture.

History and Physical Examination

• Symptoms to assess: Fatigue, frequent infections, easy bruising, left upper quadrant pain, abdominal fullness, early satiety.

• Skin and mucosa: Look for pallor, ecchymoses, or signs of bleeding tendencies.

• Lymph nodes: Palpate axillae, groin, and neck for lymphadenopathy.

• Additional findings: Hepatomegaly, jaundice, or signs of systemic disease depending on the underlying cause.

Medical causes

Special considerations

• Prepare for diagnostic studies: Complete blood count, blood cultures, abdominal CT, and radionuclide scans.

• Avoid trauma to enlarged spleen.

• Monitor for hematologic and infectious complications.

Patient counseling

• Educate on infection prevention.

• Stress compliance with prescribed therapy.

• Advise avoidance of activities that risk abdominal trauma.

Pediatric pointers

• Causes may include histiocytic disorders, congenital hemolytic anemias, Gaucher’s disease, Niemann-Pick disease, hereditary spherocytosis, sickle cell disease, beta-thalassemia.

• Splenic abscess is a common cause in immunocompromised children.

References

1. Berkowitz CD. Berkowitz’s Pediatrics: A Primary Care Approach. 4th ed. American Academy of Pediatrics; 2012.

2. Buttaro TM, Tybulski J, Bailey PP, Sandberg-Cook J. Primary Care: A Collaborative Practice. Mosby Elsevier; 2008.

3. McCance KL, Huether SE, Brashers VL, Rote NS. Pathophysiology: The Biologic Basis for Disease in Adults and Children. Mosby Elsevier; 2010.

4. Sommers MS, Brunner LS. Pocket Diseases. F.A. Davis; 2012.

5. Robbins SL, Cotran RS, Kumar V. Robbins and Cotran Pathologic Basis of Disease. 10th ed. Elsevier; 2021.

6. Habif TP. Clinical Dermatology: A Color Guide to Diagnosis and Therapy. 7th ed. Elsevier; 2021.

7. McCance KL, Huether SE. Pathophysiology: The Biologic Basis for Disease in Adults and Children. 8th ed. Elsevier; 2019.

8. Kumar V, Abbas AK, Aster JC. Basic Pathology. 11th ed. Elsevier; 2020.

9. Harrison’s Principles of Internal Medicine, 21st ed. McGraw-Hill; 2022.

10. Longo DL, Fauci AS, Kasper DL, et al. Harrison’s Manual of Medicine. 20th ed. McGraw-Hill; 2021.