Print Friendly, PDF & Email



Causes of splenomegaly

  • Portal hypertension (33%)
    • Chronic liver disease
    • Portal/splenic venous obstruction; Budd-Chiari; heart failure
  • Haematological (30%)
    • Lymphoproliferative (usually with nodes)
      • Leukaemias (AML, CML, ALL, CLL)
      • Lymphomas
    • Myeloproloferative (usually without nodes)
        • Myelofibrosis
        • Polycythaemia rubra vera (PRV)
        • Essential thrombocythaemia
    • Haemolytic anaemias
      • Hb disorders: Thalassaemia, sickle cell disease (eventually leads to splenic atrophy)
      • Red cell structure: Spherocytosis/elliptocytosis
      • Enzyme: G6PD deficiency, pyruvate kinase deficiency
  • Infection
    • Viral hepatitis
    • EBV, CMV, HIV
    • Bacterial
      • Infective endocarditis
    • Foreign/tropical
      • Malaria
      • Schistosomiasis
      • Visceral leishmaniasis (Kala-azar)
    • Tuberculosis, brucellosis
    • Hydatid cyst
    • Splenic abscesses
  • Infiltration
    • Amyloidosis
  • Connective tissue disorders
    • SLE
    • RA (Felty’s syndrome: triad of RA, neutropenia and splenomegaly)
  • Splenic metastases
  • Genetic
    • Gaucher’s disease, Niemann Pick, Histiocytosis X


Massive splenomegaly Moderate splenomegaly Mild splenomegaly
Myelofibrosis Lymphoproliferative PRV
CML Portal hypertension Haemolysis
Malaria Thalassaemia Infection
Visceral leishmaniasis Glycogen storage disorders Infiltration
Connective tissue disorders


 History in splenomegaly

  • Presenting complaint
    • Abdominal distension
    • Abdominal pain
    • Constitutional symptoms: nights sweats, fever, weight loss, malaise
    • Abnormal bruising/bleeding
  • Past medical history
    • Malignancy
    • Connective tissue disease
  • Family history
    • Malignancy
  • Social history
    • Alcohol consumption
    • Travel history
    • Risk factors for viral hepatitis (see pages on viral hepatitis)


 Examination of splenomegaly

  • Anaemia
  • Lymphadenopathy
  • Signs of chronic liver disease
  • Splenomegaly (differentiation from kidney)
    • Spleen has a medial notch, kidney doesn’t
    • You can’t get above the spleen (ribs overly it)
    • The spleen moves towards RIF with inspiration, the kidney moves posterior only (if at all)
    • The spleen is not ballotable like the kidney


 Initial investigation of splenomegaly

  • Blood tests:
    • Full blood count
    • Blood film
    • Liver function tests
    • Urea and electrolytes
    • Autoimmune screen
    • Inflammatory markers
    • LDH
  • Ultrasound of abdomen


Further investigation and management of splenomegaly depends on cause but can include

  • CT abdomen/pelvis
  • Bone marrow aspirate and trephine
  • Lymph node biopsy
  • Full liver screen


Click here for medical student OSCE and PACES questions about splenomegaly

Common splenomegaly exam questions for medical students, finals, OSCEs and MRCP PACES


Click here to download free teaching notes on splenomegaly: Splenomegaly

Perfect revision for medical students, finals, OSCEs and MRCP