SPLENOMEGALY

Harrison's Principles of Internal Medicine, 19th Edition

pp. 409-413
CLINICAL ASSESSMENT
SPLEEN
-

normal weight <250g

usually cannot be palpated
decreases in size with age

PE: PERCUSSION
1. Nixons Method
patient is placed on the right side
percussion begins at the lower level of
pulmonary resonance in the posterior
axillary line
proceeds diagonally along a
perpendicular line toward the lower
midanterior costal margin
normal spleen: upper border dullness 6
8 cm above the costal margin
splenic enlargement: dullness >8 cm in
an adult
2. Castells Method
patient in supine
percussion in the lowest intercostal
space in the anterior axillary line (eighth
or ninth)
Normal spleen: resonant on expiration
or full inspiration
splenic enlargement : dull percussion
note on full inspiration
3. Percussion of Traubes semilunar space
patient is supine with the left arm slightly
abducted
traube space is percussed from medial
to lateral margins
normal spleen: resonant
splenic enlargement: dull percussion
note
PE: PALPATION
1. Bimanual palpation least as reliable
2. Ballottement
3. Middleton maneuver palpation from above

Symptoms
Pain and heavy sensation in the LUQ
d/t acute swelling with stretching, infarction
or inflammation of the capsule
Early satiety (massive splenomegaly)
Sign
Palpable spleen
IMAGING
1. Ultrasonography
- procedure of choice for routine
assessment of spleen size
- maximum cephalocaudad diameter of 13
cm
2. Liver-spleen radionuclide scan
- maximum length of 12 cm and/or width of
7 cm
3. CT
4. MRI
LABORATORY ASSESSMENT

CBC
- may reveal cytopenia of one or more
blood cell types suggest
hypersplenism characterized by
splenomegaly, cytopenia(s), normal or
hyperplastic bone marrow, and a
response to splenectomy

SPLENECTOMY
Performed for:
1. Symptom control in patients with massive
splenomegaly
2. Disease control in patients with traumatic /
iatrogenic splenic rupture
- can cause peritoneal seeding of splenic
fragments that can lead to splenosis
ectopic spleen (spleen tissue not
connected to portal circulation) may
cause pain or GI obstruction
3. Correction of cytopenias in patients with
hypersplenism or immune-mediated
1

destruction of one or more cellular blood

elements
4. Necessary for staging of patients with
Hodgkins disease (clinical stage I or II
disease) in whom radiation therapy alone is
contemplated as the treatment
5. Effective secondary or tertiary treatment for
hairy cell leukemia and prolymphocytic
leukemia, and for the very rare splenic
mantle cell or marginal zone lymphoma
6. Abscopal effect regressions of systemic
disease after splenic irradiation in some
types of lymphoid tumors (CLL,
prolymphocytic leukemia)
COMPLICATIONS

1. Increased susceptibility to bacterial

infections (e.g., Streptococcus pneumoniae,
Haemophilus influenzae, some gram
negative enteric organisms)
- d/t inability to remove opsonized
bacteria from the bloodstream and a
defect in making antibodies to T cell
independent antigens such
- Pneumococcal vaccine should be
administered to all patients 2 weeks
before elective splenectomy
- Advisory Committee on Immunization
Practices recommends patients to
receive repeat vaccination 5 years after
splenectomy
2. Vulnerability to parasitic disease (e.i.,
babesiosis)
3. Hyposplenism