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Splenomegaly

Clinical Subject Page

Splenomegaly

Splenomegaly is an abnormal enlargement of the spleen. It is not a disease by itself but usually indicates an underlying infection, liver disease, hematological disorder, malignancy, or systemic inflammatory condition.

Also called

Enlarged spleen

ICD-10

R16.1

Specialty

Gastroenterology

Onset

Chronic

Reviewed

July 2026

On This Page

Overview

Splenomegaly develops when the spleen enlarges because of increased immune activity, blood-cell destruction, venous congestion, abnormal cell infiltration, or increased blood-cell production. Patients may be asymptomatic or present with left upper-quadrant discomfort, early satiety, anemia, recurrent infections, or easy bleeding. Ultrasound is commonly used to confirm enlargement, while further investigations aim to identify the underlying cause.

Etiology & Risk Factors

Aetiology and Risk Factors

-Liver and Vascular Causes

  • Liver cirrhosis

  • Portal hypertension

  • Portal vein thrombosis

  • Splenic vein thrombosis

  • Congestive heart failure

  • Budd–Chiari syndrome

-Infectious Causes

  • Infectious mononucleosis

  • Viral hepatitis

  • HIV infection

  • Malaria

  • Tuberculosis

  • Brucellosis

  • Infective endocarditis

  • Visceral leishmaniasis

-Hematological Causes

  • Hemolytic anemia

  • Sickle cell disease

  • Thalassemia

  • Hereditary spherocytosis

  • Autoimmune hemolytic anemia

  • Myelofibrosis

  • Polycythemia vera

-Malignant Causes

  • Leukemia

  • Lymphoma

  • Myeloproliferative neoplasms

  • Metastatic malignancy

-Autoimmune and Inflammatory Causes

  • Rheumatoid arthritis

  • Felty syndrome

  • Systemic lupus erythematosus

  • Sarcoidosis

  • Systemic inflammatory disorders

Pathophysiology

Underlying disease → increased splenic workload, venous congestion, abnormal cellular infiltration, or excessive blood-cell sequestration → enlargement of the spleen → increased trapping and destruction of blood cells → possible hypersplenism and cytopenias.

Clinical Presentation

  • Common symptoms include:

    • Left upper-quadrant discomfort or pain
    • Feeling of fullness beneath the left ribs
    • Early satiety due to pressure on the stomach
    • Abdominal fullness
    • Fatigue
    • Weight loss
    • Fever or night sweats
    • Easy bruising or bleeding
    • Recurrent infections

History Taking

  • Ask about:

    • Left upper-quadrant discomfort or fullness
    • Early satiety
    • Fever or recent infection
    • Weight loss or night sweats
    • Fatigue or pallor
    • Easy bruising or bleeding
    • Recurrent infections
    • Jaundice or dark urine
    • Abdominal swelling
    • Alcohol use
    • Known liver disease
    • Recent travel to malaria-endemic regions
    • Hematological disease or malignancy
    • Autoimmune disease
    • Recent abdominal trauma

Physical Examination

  • General Examination

    Look for:

    • Pallor

    • Jaundice

    • Fever

    • Weight loss

    • Lymphadenopathy

    • Bruising or petechiae

    • Signs of chronic liver disease

    Abdominal Examination

    Assess for:

    • Palpable spleen below the left costal margin

    • Splenic tenderness

    • Hepatomegaly

    • Ascites

    • Abdominal distension

    • Signs of portal hypertension

    An enlarged spleen typically moves downward with inspiration and may have a palpable notch along its medial border.

    Other Examination

    Look for:

    • Cardiac murmurs suggesting infective endocarditis

    • Joint inflammation

    • Skin rashes

    • Peripheral edema

    • Signs of hematological malignancy

Investigations

  • Initial Laboratory Tests

    • Complete blood count

    • Peripheral blood smear

    • Reticulocyte count

    • Liver function tests

    • Renal function and electrolytes

    • C-reactive protein and ESR

    • Coagulation profile

    • Lactate dehydrogenase

    • Bilirubin

    • Haptoglobin

    • Viral serology when indicated

    • Blood cultures if infection is suspected

    Additional Tests Based on Suspected Cause

    • Malaria blood film

    • Monospot test or EBV serology

    • HIV testing

    • Hepatitis serology

    • Autoimmune screening

    • Hemoglobin electrophoresis

    • JAK2 mutation testing

    • Bone marrow examination

    • Flow cytometry

    Imaging

    Abdominal Ultrasound

    Usually the first imaging test because it can:

    • Confirm splenic enlargement

    • Measure spleen size

    • Assess liver disease

    • Detect portal hypertension

    • Identify focal splenic lesions

    CT Abdomen

    Used when:

    • Malignancy is suspected

    • Splenic lesions are present

    • Complications are suspected

    • More detailed abdominal assessment is required

    Doppler Ultrasound

    May assess:

    • Portal vein thrombosis

    • Splenic vein thrombosis

    • Portal blood flow

Diagnosis

  • Diagnosis requires:

    • Confirmation of splenic enlargement by examination or imaging
    • Identification of the underlying cause

    Splenomegaly should not be considered the final diagnosis until liver disease, infection, hematological disease, malignancy, and autoimmune conditions have been assessed.

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Related Topics

Management

  • General Management

    • Treat the underlying cause

    • Avoid contact sports and abdominal trauma

    • Provide analgesia when needed

    • Monitor blood counts

    • Manage anemia, thrombocytopenia, or infection

    • Refer to hematology or hepatology when indicated

    Cause-Specific Management

    • Antibiotics for bacterial infection

    • Antiparasitic treatment for malaria or leishmaniasis

    • Antiviral or supportive care for viral infections

    • Treatment of portal hypertension

    • Management of cirrhosis

    • Chemotherapy or targeted therapy for hematological malignancy

    • Immunosuppressive therapy for selected autoimmune disorders

    • Treatment of hemolytic anemia

    Splenectomy

    Splenectomy is rarely used only to treat splenomegaly itself. It may be considered for:

    • Severe hypersplenism

    • Symptomatic massive splenomegaly

    • Recurrent splenic complications

    • Selected hematological disorders

    • Suspected or confirmed splenic malignancy

    • Splenic rupture

Complications

  • Hypersplenism
  • Anemia
  • Leukopenia
  • Thrombocytopenia
  • Recurrent infection
  • Easy bleeding
  • Splenic infarction
  • Splenic rupture
  • Abdominal discomfort
  • Early satiety and poor nutrition

Prognosis

The prognosis depends on the underlying cause. Mild enlargement related to a temporary infection may resolve completely, while splenomegaly caused by cirrhosis, hematological malignancy, or chronic inflammatory disease may persist and require long-term management.

Key Points / Clinical Pearls

  • Splenomegaly means abnormal enlargement of the spleen.
  • It is usually secondary to another disease.
  • Common causes include liver disease, infection, hemolytic anemia, and hematological malignancy.
  • Patients may have left upper-quadrant discomfort or early satiety.
  • CBC, blood smear, liver tests, and abdominal ultrasound are important initial investigations.
  • Management focuses on treating the underlying cause.
  • Patients should avoid abdominal trauma because an enlarged spleen is more vulnerable to rupture.