Splenomegaly

Background

• Hypersplenism is defined as splenomegaly with any of: anemia, leukopenia, or thrombocytopenia, which are expected to correct after splenectomy
  • All patients with hypersplenism have splenomegaly, but not all patients with splenomegaly have hypersplenism
  • Mostly secondary to other process, but rarely can be primary

Differential Diagnosis

• See also massive splenomegaly
• Infectious
  • Acute
    • Viral: viral hepatitis, infectious mononucleosis, CMV
    • Bacterial: sepsis, salmonellosis, brucellosis, splenic abscess
    • Parasite: toxoplasmosis
  • Subacute or chronic
    • Subacute bacterial endocarditis
    • Tuberculosis
    • Malaria
    • Visceral leishmaniasis
    • Fungal infections
• Inflammatory
  • Felty syndrome
  • Systemic lupus erythematosus
  • Serum sickness
  • Rheumatic fever
  • Sarcoidosis
  • Antiphospholipid antibody syndrome
• Congestive
  • Intrahepatic: cirrhosis
  • Extrahepatic:
    • Portal vein thrombosis
    • Splenic vein obstruction
    • Budd-Chiari syndrome
  • Heart failure
• Hematologic
  • RBC disorders
    • Hemolytic anemia
    • Thalassemia
    • Sickle cell disease
  • Neoplasia
    • Malignant
      • Myeloproliferative disorder
      • Myeloid metaplasia
      • Polycythemia rubra vera
      • Essential thrombocythemia
      • Chronic leukemia
      • Chronic myeloid leukemia
      • Chronic lymphocytic leukemia
      • Hairy cell leukemia
      • Lymphoma
      • Acute leukemia
      • Malignant histiocytosis
    • Benign
      • Hamartoma
      • Hemangioma
      • Lymphangioma
      • Fibroma
• Genetic/metabolic
  • Gaucher disease
  • Niemann-Pick disease
• Other
  • Amyloidosis
  • Splenic cyst