Splenomegaly is defined by enlarged splenic dimensions, typically categorized as mild, moderate, or massive based on size and weight. It can arise from various causes, including infections, cirrhosis, and other diseases, with associated symptoms such as fever and abdominal pain. Diagnosis involves imaging techniques and blood tests, with severe cases possibly leading to splenectomy.

2.  Splenomegaly
Definition
Classification
Etiology
Symptom
Diagnosis
References

4. Splenomegaly is defined by increased splenic
dimensions and volume.
Spleen diameters averaged over 13 cm and an area
above 45 cm2 or weight above 400 g are considered
splenomegaly.

5. Normal Spleen Splenomegaly

6. Splenomegaly can be classify as;
Mild
Moderate
Massive

7. Mild Splenomegaly
 Just palpable
 (1-3) cm more than normal
spleen ≈ 14cm - 16 cm
 Spleen > 400 g < 1000 g
Mild Splenomegaly with Cirrhosis

8. Moderate Splenomegaly
Between costal margin & umbilicus
 (4-8) cm more than normal spleen ≈ 17 cm – 21 cm
Spleen > 400 g <1000 g
Splenic Area 45 cm2 -65 cm2

9. Massive Splenomegaly
Beyond umblicus, crosses mid line into pelvis
Spleen > 8cm than normal
 Spleen > 1000g
 Splenic area > 65 cm2

11. Splenomegaly (Splenic Length) Age Group
>6.0 cm 3 months
>6.5 cm 6 months
>7.0 cm 12 months
>8.0 cm 2 years
>9.0 cm 4 years
>9.5 cm 6 years
>10.0 cm 8 years
>11.0 cm 10 years
>11.5 cm 12 years
>12.0 cm 15 years

12. Splenomegaly due to exaggerated forms of normal splenic function;
- infections or inflammatory processes results from an increase in the
defense activities of the organ
- Removal of abnormal blood cells from the circulation is the usual
source of hyperplastic splenomegaly.
- Cirrhosis with portal hypertension, splenic vein occlusion or
congestive heart failure (CHF) causes congestive splenomegaly
- Infiltrative splenomegaly is the result of swelling of macrophages
with indigestible materials.

13. Cysts,
Hemangiomas,
Other malformations.
Several diseases can lead to splenomegaly; malaria,
anemias etc.

14. Associated symptoms or signs are typically related to the underlying
disorder.
 Fever
 Left Upper Quadrant pain (splenic infarct) (localize area of dead cell)
 Fullness and early satiety
 Feeling of heaviness in LUQ
 Jaundice

15. Most practical and cost effective method
Perform a complete blood count (CBC) with differential, platelet count,
and peripheral blood smear
 Computed Tomography
 Magnetic Resonance Imaging,
 Ultrasonography (High sensitivity & specificity, safe, noninvasive, quick, mobile, and
less costly)

16. Splenic Dimensions
Splenic Contour (Rounded Edge)
 Dilated Splenic vein (> 9 mm)
- Homogenous, slightly hyperechoic, with mild-
to-low echogenicity compare to liver, a smooth contour.

17. Massive Splenomegaly
Mild irregular contour and inhomogeneous echo-structure with diffuse hyperechoic foci
suggesting small infarctions

18. Splenomegaly with Splenic Vein Dilation

20. If the spleen is minimally enlarged, may be followed with careful
and regular observation.
Patients with enlarged spleens are more likely to have splenic
rupture from blunt abdominal or low thoracic trauma.
Splenomegaly most likely result in splenectomy

21.  Swaoop J, O’Reily RA. Splenomegaly at a University Hospital
compared to a nearby county hospital in 317 patients. Acta
Haematol 1999;102:83-8.
Ioanitescu S, Iliescu L, Harza M, Ismail G, Copaci I. Ultrasound of
the spleen, EFSUMB Course Book;1-46. Published by EFSUMB,
2012.
 Radhakrishnan N, Besa,C, E. Splenomegaly. Medscape. 2018
January 09;1-9
 World Health Organisation, World Federation for Ultrasound in
Medicine and Biology: Manual of Diagnostic ultrasound; 2003