Overview
Splenomegaly
1. Clinical Overview
Summary
Splenomegaly is enlargement of the spleen beyond normal size. Causes include haematological disorders (lymphoma, leukaemia, haemolytic anaemia), infections (EBV, malaria), portal hypertension, and inflammatory conditions. Massive splenomegaly (extends into pelvis) suggests myelofibrosis, CML, malaria, or visceral leishmaniasis. Investigation aims to identify the underlying cause.
Key Facts
- Definition: Spleen palpable below left costal margin (normal 12cm on USS)
- Common causes: Infection (EBV), haematological malignancy, portal hypertension
- Massive splenomegaly: Myelofibrosis, CML, malaria, Gaucher's
2. Causes
| Category | Examples |
|---|---|
| Haematological | CML, CLL, lymphoma, myelofibrosis, haemolytic anaemia |
| Infective | EBV, malaria, endocarditis, TB |
| Portal hypertension | Cirrhosis |
| Inflammatory | Sarcoidosis, SLE, RA (Felty's) |
| Storage | Gaucher's, Niemann-Pick |
3. Investigation
| Test | Purpose |
|---|---|
| FBC, film | Blood dyscrasias |
| LFTs | Liver disease |
| Monospot/EBV | Infection |
| Ultrasound | Confirm size |
| CT | Further characterisation |
| Bone marrow | If haematological cause suspected |
Last Reviewed: 2026-01-01 | MedVellum Editorial Team