Diagnosis
A healthy spleen with the usual size cannot be felt by palpating the abdomen. Massive splenomegaly and a very large organ can be detected in the physical exam. However, even when it is, this finding should be confirmed with imaging tests.
Physical examination of the spleen should be performed with the patient in a supine position or laying on their right side. This position allows for a partial relaxation of the abdomen and a rotation of the spleen that contributes to feeling any increase in size. The doctor will ask the patient to take a deep breath and follow the outline of the spleen. The organ is only palpable in 3% of patients with a normal spleen.
After confirming the finding with imaging tests, doctors may need to order a few tests to rule out the list of diseases above. They include:
- A complete blood count to rule out infections, anemia, and platelet alterations
- Liver function tests to rule out liver disease, which is usually associated with splenomegaly
- A CT scan to evaluate the presence of a splenic abscess and cancer
- Rheumatologic panel, because the rheumatic condition is one of the causes of splenomegaly
The cause of splenomegaly should be evaluated depending on the course of the disease. Acute and subacute illnesses should be assessed based on the presence of fever and skin rashes. For instance, patients with fever and rash should rule out leukemia and other blood-related alterations. Patients without fever and without rash could have hemolytic anemia if they also have jaundice or polycythemia vera if they do not.
Things to consider in case of splenomegaly
- Splenomegaly is not as common as hepatomegaly, and it is a more dangerous problem because a swollen spleen is more susceptible to splenic rupture.
- The most common cause of splenomegaly in immunocompromised children is a splenic abscess. Other causes in the pediatric population include congenital hemolytic anemia, Gaucher’s disease, and others.
- Complying with drug therapy is particularly important in these cases, and most patients with splenomegaly should be cautious with infections. In some cases, the immune system is deeply compromised and may lead to further alterations.
References
Chapman, J., Bansal, P., Goyal, A., & Azevedo, A. M. (2017). Splenomegaly.
Suttorp, M., & Classen, C. F. (2021). Splenomegaly in children and adolescents. Frontiers in Pediatrics, 9.
Pozo, A. L., Godfrey, E. M., & Bowles, K. M. (2009). Splenomegaly: investigation, diagnosis and management. Blood reviews, 23(3), 105-111.
McKenzie, C. V., Colonne, C. K., Yeo, J. H., & Fraser, S. T. (2018). Splenomegaly: pathophysiological bases and therapeutic options. The international journal of biochemistry & cell biology, 94, 40-43.
