It can be detected on physical examination by using castells sign, traubes space percussion or nixons sign, but an ultrasound can be used to confirm diagnosis. Splenomegaly can be caused due to various medical conditions like some sort of an infection or problems with the liver. Although splenomegaly is often considered to be an ominous clinical finding, certain normal variants have been found. Patients and methods we identified 129 patients through the dnrp, that had been given the icd10 splenomegaly diagnosis code in 199420 at odense university hospital, denmark, excluding. Get a printable copy pdf file of the complete article 1. There are different medical conditions that can lead to the simultaneous appearance of hepatomegaly and splenomegaly, as you will have the opportunity to discover below. Splenomegaly causes of splenomegaly portal hypertension 33% chronic liver disease portalsplenic venous obstruction. Ct and mri may provide more detail of the organs consistency. Splenic palpation for the evaluation of morbidity due to. The purpose of both palpation and percussion of the spleen is to look for splenic enlargement. Early satiety from gastric displacement occurs with massive splenomegaly.
The spleen is a fistsized organ in the upper left side of your abdomen, next to your stomach and behind your left ribs. The differential diagnosis of splenomegaly includes. Although studies on hypersplenism are few, two studies have shown that schistosomal portal hypertension is the commonest cause of hypersplenism, other common causes include hematological disorders, and visceral lesihmaniasis. All clinical records including laboratory result and medical imaging. In an age when ever more refined laboratory tests are the keynote, it may seem anachronistic to describe again a simple method in bedside diagnosis. Spleen problems and spleen removal some people are born without a spleen or need to have it removed because of illness or injury. Evaluation of splenomegaly approach bmj best practice.
It is important to understand that this condition can lead to a serious or lifethreatening symptoms, if proper medical treatment. Splenomegaly general presentation the spleen is a hematopoietic organ supporting the megakaryotic, lymphoid, erythroid, myeloid, and reticuloendothelial systems. Know the causes, symptoms, and treatment of splenomegaly. The differential diagnosis for splenomegaly is broad but can be grouped into. In children, as a result of the thinness of the abdominal musculature, a palpable spleen is commonly encountered. In cases in which splenomegaly is questioned, the clinical examination is more specific than sensitive and is best used when ruling in the diagnosis among patients for whom the suspicion is at least 10%. The evaluation of splenomegaly in children and considerations related to elective or traumatic splenectomy are discussed separately. Patients may also experience pain,which may be referred to the left shoulder. Any conditions that cause a rapid breakdown of blood cells, such as any of the haemolytic anaemias, can place great strain on the spleen and make it enlarge. Pdf hypersplenism is a condition in which the spleen becomes increasingly active and then rapidly removes the blood cells. Hepatosplenomegaly is a medical condition in which both the liver and the spleen become enlarged. One third of neonates and one tenth of children may have a normal, palpable spleen.
Even in palpable splenomegaly, radiological assessment is usually necessary to quantitate the abnormality, as discussed above. Splenomegaly may be a presenting or dominant feature of certain diseases. Pointofcare ultrasonography improves the diagnosis of splenomegaly in hospitalized patients article pdf available in critical ultrasound journal 71. It enlarges towards the right iliac fossa rif always start palpation in the rif and move across towards the right upper quadrant or a massive splenomegaly may be missed. Splenomegaly can be found in 3% of the normal population. Pointofcare ultrasonography improves the diagnosis of splenomegaly in hospitalized patients.
Congestion cirrhosis, hepatic fibrosis, portal vein thrombosis, splenic vein thrombosis, longstanding congestive heart failure. Conclusion our findings show that the splenomegaly diagnosis in the dnrp is. Clinical examination for splenomegaly is of questionable value even in the hands of experienced providers. Cause of splenomegaly is obscurelymphocytic infiltration of splenic liver sinosoids present. Since the spleen enlarges in many conditions, a systematic approach may facilitate timely and costeffective diagnosis of the cause of splenomegaly. Up to 3% of normal, thin, people have a palpable spleen. Your spleen is a fistsized organ located behind your stomach and just under your left rib cage. A 48 yearold woman with abdominal cramping, vomiting, and no bowel movement for 2 days.
The most common complaint in patients with splenomegaly is mild, vague, abdominal discomfort. The differential diagnosis of splenomegaly is extensive table 1. To determine whether sonographic versions of physical examination. It may also be felt in 1% of normal older children and adolescents. Describe how the physical examination affects the physicianpatient. If you understand the normal and abnormal characteristics of each organ system, you will recognize the pattern of the syndrome and reach the correct diagnosis. Causes of massive splenomegaly beyond umbilicus in very large spleen lower splenic pole may extend into pelvis and cross abdominal midline. Signs of splenomegaly may include a palpable left upper quadrant abdominal mass or splenic rub. A small percentage of the normal american population may have a palpable or enlarged spleen. Imaging also delineates the architecture of the enlarged spleen, and distin. Population for whom the physical examination of splenomegaly should be sought.
Prevalence and clinical significance of splenomegaly in. Physical diagnosis of the abdomen university of virginia. Because the physical examination is quite insensitive for detecting splenomegaly between 27 and 58 percent, depending on the examiners index of suspicion, the absence of splenomegaly should not be used as evidence against the diagnosis of infectious mononucleosis. When considering whether an luq mass is an enlarged spleen, features of an enlarged spleen include that. In case if an enlarged spleen or splenomegaly is suspected imaging studies and blood tests will be done to. Also, a palpable left upper quadrant mass may indicate a problem other than an enlarged spleen. Diagnosis is based on either the presence of 5 out of 8 criteria fever, splenomegaly, bicytopenia, hypertriglyceridemia andor hypofibrinogenemia, hemophagocytosis, low or absent nkcell activity, hyperferritinemia, and high levels of soluble interleukin2 receptor, or a molecular diagnosis consistent with hlh. The sensitivity for detection of ultrasounddocumented splenic enlargement is 60 to 70% for palpation and 60 to 80% for percussion. Its causes include a variety of conditions that affect these two organs, including liver disease, hiv, anemia, infections, and. During two evaluations of refugee populations in western uganda in march and july 2015, refugees with splenomegaly on physical examination were offered additional assessment and treatment, including abdominal ultrasonography and laboratory testing. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. Myeloproliferative disorder proliferation of stem cells chronic myeloid leukemia polycythemia thrombocytosis 2.
In normal individuals or in patients with mild splenomegaly, the spleen generally retains its usual tetrahedral shape and there appears to be a good cor relation between measurements whether by mr, ct or ultrasound 1. Each patient was examined for splenomegaly using conventional. In part this is because the spleen enlarges in the inferior anteromedial direction, sometimes as far as the rlq. Clinical approach to isolated splenomegaly association physicians. Participants received less than 1 h training for ultrasound diagnosis of splenomegaly. Physical diagnostic techniques for the detection of splenomegaly are relatively insensitive but specific. Splenomegaly increases the spleens mechanical filtering and destruction of red blood cells rbcs and often of white blood cells wbcs and platelets. An enlarged spleen is usually detected during a physical exam. A detailed history taking, appropriate clinical examination and relevant. Comparing physical examination with sonographic versions of the. The classic causes of massive tropical splenomegaly are hyperreactive malarial splenomegaly formerly tropical splenomegaly syndrome1, schistosomiasis, visceral leishmaniasis, thalassaemia major, chronic myeloid leukaemia, myelofibrosis, and miscellaneous disorders such as splenic cysts, tumours, and lipid storage diseases.
Splenomegaly hematology and oncology merck manuals. These maneuvers have received more extensive evaluation than other maneuvers, allowing us greater confidence in the findings. All reported studies discuss splenomegaly arising from im and the assumption is made that detection of enlargement from other etiologies would not differ on physical examination. Splenomegaly is an exception rather than the rule, and the hematologic profile is that of selective absence or reduction in the number of neutrophils, while monocytes, eosinophils, and basophils are either normal or increased. Recent trauma in area of spleen associated symptoms asymptomatic causes of initially asymptomatic splenomegaly may include early myelproliferaitve disorders, splenic cyst, mild hereditary spherocytosis and even. Olson ap, trappey b, wagner m, newman m, nixon lj, schnobrich d.
In the past, splenomegaly was a clinical finding, but in recent years, imaging studies have also helped to assess for or confirm mild splenomegaly. Moreover, the examination should start with traube space percussion, followed, if dull, by supine 1handed palpation. Sep 17, 2015 this was a prospective trial of diagnostic accuracy. However, when the tip of the spleen is felt beyond 2 cm below the left costal margin, it is considered abnormal. Comparing physical examination with sonographic versions of. Hepatosplenomegaly hpm is a disorder where both the liver and spleen swell beyond their normal size, due to one of a number of causes. If confirmation of splenomegaly is necessary because the examination is equivocal, ultrasonography is the test of choice because of its accuracy and low cost. Palpation and percussion of the spleen are important techniques for identifying an enlarged. Treatment for splenomegaly treatment for splenomegaly depends on the underlying condition. Diagnosis of splenomegaly diagnosing splenomegaly involves a number of tests, including. However, a variety of disorders can cause the spleen to enlarge, sometimes to 2kg or more. Most often, the etiology is evident in light of historical and genealogical information and the concurrent presence of familiar, often pathognomonic, physical or laboratory findings e. For the clinical diagnosis of splenomegaly, two criteria have been tested.
What is splenomegalycausessymptomstreatmentdiagnosis. To determine whether sonographic versions of physical examination techniques can accurately identify splenomegaly, castells method ann intern med 1967. The spleen is felt in 30% of normal newborns and up to 10% of one year olds. Assessment of splenomegaly differential diagnosis of. Splenomegaly is a frequent finding among hivinfected adults 1, 2. The algorithms herein attempt to present a rational, stepbystep diagnostic. Hypersplenism is a secondary process that can arise from splenomegaly of almost any cause see table common causes of splenomegaly. Pdf pointofcare ultrasonography improves the diagnosis of. Pointofcare ultrasonography improves the diagnosis of. If your institution subscribes to this resource, and you dont have a myaccess profile, please contact your librarys reference desk for information on how to gain access to this resource from offcampus. Examiner dependence on physical diagnostic tests for the. Enlarged spleen splenomegaly may be easier to palpate during careful abdominal examination. Although several methods of palpation and percussion of the spleen have been described, until recently they have not been validated by noninvasive imaging techniques such as ultrasonography, radionuclide scanning, and computed tomography that offer objective means to assess splenomegaly. If your institution subscribes to this resource, and you dont have a myaccess profile, please contact your librarys reference desk for information on how to.
Tuberculous splenomegaly with the hypersplenism syndrome. Brucellosis schistosomiasis stool ova and parasite s. The spleen is enlarged in a number of important clinical diagnoses. Articles causes of massive tropical splenomegaly in ghana. Physical examination inspection, palpation, percussion, auscultation, vital signs, weight, height 3. Spleen exam stanford medicine 25 stanford medicine. A combination of tests either palpation or percussion increased the diagnostic accuracy. A normalsized spleen cannot be palpated felt during the physical examination of the abdomen, except in slender people. The spleen is a functionally diverse organ with active roles in immunosurveillance and hematopoiesis. Portal hypertension is an important cause of splenomegaly in most tropical countries. Splenomegaly increases the spleen s mechanical filtering and destruction of red blood cells rbcs and often of white blood cells wbcs and platelets. In this study there was high interobserver variability, which did not appear to be associated to the level of experience. Tuberculous splenomegaly 1 thought that the term primary tb of the spleen is misleading considered that tuberculosis of the spleen must always be secondary. Tropical splenomegaly massive splenomegaly occurring in people of endemic area for malariakalaazar but no parasite is demonstrable in blood.
Reasons for feeling a normal spleen include an unusual position and being pushed down by hyperexpanded lungs. The content on the uptodate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. The main modalities used are ultrasound and ct fig. Splenomegaly, hypersplenism, and hereditary disorders with. Pdf purpose our aim was to assess the validity of the icd10 code for. Your doctor can often feel it by gently examining your left upper abdomen. Implicit in the definition is that the cytopenias will correct after splenectomy. It is a reservoir for platelets and a site for the proliferation of blymphocytes. These maneuvers have received more extensive evaluation than other maneuvers.
Anatomy develops from condensations of mesoderm in the dorsal mesogastrium. A list of disorders producing splenomegaly and hypersplenism is presented in table 2. An increase in the size of the spleen can be caused by several mechanisms. Diagnosis is based on either the presence of 5 out of 8 criteria fever, splenomegaly, bicytopenia, hypertriglyceridemia andor hypofibrinogenemia, hemophagocytosis, low or absent nkcell activity, hyperferritinemia, and high levels of soluble interleukin2 receptor, or a molecular diagnosis.
The term splenomegaly generally denotes a palpably enlarged spleen. Although splenomegaly is almost always present in hypersplenism, many patients with splenomegaly do not have hypersplenism. However, little is known about the prevalence and clinical significance of this finding in asymptomatic patients. Hepatosplenomegaly refers to an enlargement of the liver and spleen. Pdf the detection of an enlarged spleen is important in clinical diagnosis but seems to be subject to considerable inaccuracies. This topic provides an overview of normal splenic size and function and an approach to evaluating splenic abnormalities in adults. The physical examination for splenomegaly had a sensitivity of 40 % 95 % ci 1277 % and specificity of 88 % 95 % ci 7495 % while physical examination plus pocus had a sensitivity of 100 % 95 % ci 57100 % and specificity of 74 % 95 % ci 5785 %. Primary tuberculosis of the spleen coined by coley in 1846 1 refers to an enlarged spleen from tuberculosis no or little involvement of other organs 1938englebrethholm changed it to. Splenomegaly is an enlargement of the spleen resulting from abnormalities of its lymphoid, reticuloendothelial, or vascular components. On the other hand, as the spleen progressively and. Increased workload of the spleen can be caused by immunologic stress infection, inflammation, or an autoimmune disorder or by increased rbc removal rbc membrane disorders, hemoglobinopathies. Splenomegaly is defined as enlargement of the spleen, measured by size or weight. Evidencebased physical diagnosis essential here dermatologic diagnosis cellulitis zoster psoriasis neurologic diagnosis parkinsons disease bells palsy amyotrophic lateral sclerosis musculoskeletal diagnosis cardiologic diagnosis pericarditis mitral valve prolapse ophthalmologic diagnosis diabetic retinopathy psychiatric diagnosis. Splenomegaly american academy of pediatrics textbook of.
Enlarged spleen splenomegaly diagnosis and treatment. However, it may also refer to an enlarged spleen detected by an imaging test. One third of newborns and 10% of children may normally have a palpable spleen. Hypersplenism is a syndrome characterized by splenomegaly and any or all of the following cytopenias. Jan 22, 2019 splenomegaly is a pathological condition in which spleen of an individual gets enlarged. Pdf reliability of clinical techniques for detecting splenic. Spleen should be twice the normal size to become palpable.
It has been found in up to 70% in a postmortem study. It may be difficult to palpate an enlarged spleen in the settings of obesity, a muscular abdominal wall, or the inability to sufficiently relax the abdominal musculature. Diagnosis is made using criteria developed by the polycythemia vera study group. Splenomegaly pediatrics clerkship the university of. Does this patient have intestinal obstruction blockage of intestine. Igm antibodies against malaria are detected in blood. Pdf splenomegaly diagnostic validity, workup, and underlying. An enlarged spleen may not be palpable until it is 23 times its normal size. However, in some people especially those who are slender a healthy, normalsized spleen can sometimes be felt during an exam. The diagnosis of the cause requires a complete history and thorough physical examination with the following points of importance. Mri is especially useful in detecting portal or splenic vein thromboses. Other causes of splenomegaly include infections, liver disease and some cancers.
The use of manual therapy or therapeutic touch has generated extensive literature. Splenomegaly is most often discovered under physical examination. Splenomegaly and hypersplenism information page patient. Jul 08, 2019 splenomegaly in childhood is generally first suspected upon physical examination. Generally it is less than 1 cm below the left costal margin. Skills in physical diagnosis are instrumental if you desire to become an astute and competent physician. The spleen can be enlarged in up to 30% of newborns and 10% of children.
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