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Medical Author:

Siamak T. Nabili, MD, MPH

Siamak T. Nabili, MD, MPH

Dr. Nabili received his undergraduate degree from the University of California, San Diego (UCSD), majoring in chemistry and biochemistry. He then completed his graduate degree at the University of California, Los Angeles (UCLA). His graduate training included a specialized fellowship in public health where his research focused on environmental health and health-care delivery and management.

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Medical Editor:

Melissa Conrad Stöppler, MD, Chief Medical Editor

Melissa Conrad Stöppler, MD, Chief Medical Editor

Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.

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The most important aspect in evaluating splenomegaly is to find the underlying cause. Most of the time splenomegaly is detected incidentally on imaging studies, such as CT scans, that are done for another reason.

An enlarged spleen can be felt by deep palpation of the left upper abdomen during physical examination, especially with deep inspiration as the diaphragm pushes the spleen further down into the abdominal cavity. A mildly enlarged spleen may not be appreciated on an abdominal exam, unless examined carefully.

If splenomegaly is detected, a complete blood count (CBC) and a blood smear are usually ordered to review the number, shape, and composition of white blood cells, red blood cells, and platelets. Other blood tests that may be helpful include a metabolic panel (blood chemistry) and liver function tests.

Aside from CT scanning, other imaging tests which can help in evaluating splenomegaly include ultrasound of the abdomen, angiography, and liver-spleen scans.

Further evaluation may focus on determining the underlying cause of splenomegaly as guided by clinical grounds. For example:

• if lymphoma is the suspected cause for an enlarged spleen, then CT scans of chest and abdomen or a lymph node biopsy may be performed;
  
  
• or if an infection is suspected, then finding the source of the infection will become the primary objective.

A bone marrow biopsy may be done if Mycobacterium infection, Gaucher disease, or leukemia are considerations.

Biopsy of the spleen is rarely preformed, especially in the United States, because of the high risk of bleeding. Splenectomy (removing the spleen) and microscopic analysis of the removed spleen can be performed if the risk of surgery is outweighed by the value of determining the exact cause and its subsequent treatment.

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