Splenomegaly

South Tees Hospitals NHS Foundation Trust

Definition/Description

Splenomegaly may be detected due to local symptoms, such as left upper quadrant discomfort or early satiety, but more commonly it is an incidental finding on radiological imaging.

An enlarged spleen is >12-13cm length, although with borderline splenomegaly (up to approximately 14cm) and no associated systemic symptoms we often find no underlying cause. Normal spleen size varies with gender and height see expected spleen size calculator.

Red Flag Symptoms

None provided

Guidelines on Management

Differential Diagnosis:

Liver disease +/- portal hypertension. Fatty liver disease is very common.
Haematological (red cell destruction) - acquired haemolytic anaemia, red cell membrane disorder or haemoglobinopathy.
Haematological (malignancy) related to myeloproliferative disorder, lymphoma or leukaemia (may be related to systemic symptoms such as weight loss or fevers/drenching night sweats).
Autoimmune disease such as rheumatoid arthritis or systemic lupus.
Infection bacterial (e.g. endocarditis, tuberculosis), viral (e.g. HIV, EBV, CMV, hepatitis) or protozoal (e.g. tuberculosis, malaria, leishmaniasis, schistosomiasis).
Rare causes, e.g. sarcoidosis, amyloidosis or storage disorders such as Gaucher disease.

Massive splenomegaly (>20cm) is usually only seen with the causes shown in bold.

Examination:

Depends on suspected cause but include basic observations, stigmata of endocarditis, hepatomegaly / signs of liver disease and lymphadenopathy.

Baseline investigations:

Full blood count, blood film, reticulocytes, U+E, LFT, LDH, immunoglobulins, Direct Coombs test. Check HIV serology.
Other testing depending on suspected cause, e.g. haemoglobinopathy screen, autoimmune screen, infection serology / cultures, serum ACE, etc.

Referral Criteria/Information

Referral:

Haematology referral (NICE suggest 2WW, especially if concern over malignancy night sweats, fever, shortness of breath, itch or weight loss):

Suspected haematological disorder red cell disorder or malignancy.
Unexplained splenomegaly with systemic symptoms or clinical concern.
Unexplained splenomegaly >14cm in size.

If systemically well, no obvious cause and only borderline splenomegaly then we suggest repeat US scan in 4-6 months to look for evidence of further enlargement.