Enlarged Spleen (Splenomegaly)

  • Medical Author:
    Benjamin Wedro, MD, FACEP, FAAEM

    Dr. Ben Wedro practices emergency medicine at Gundersen Clinic, a regional trauma center in La Crosse, Wisconsin. His background includes undergraduate and medical studies at the University of Alberta, a Family Practice internship at Queen's University in Kingston, Ontario and residency training in Emergency Medicine at the University of Oklahoma Health Sciences Center.

  • Medical Editor: Steven Doerr, MD
    Steven Doerr, MD

    Steven Doerr, MD

    Steven Doerr, MD, is a U.S. board-certified Emergency Medicine Physician. Dr. Doerr received his undergraduate degree in Spanish from the University of Colorado at Boulder. He graduated with his Medical Degree from the University Of Colorado Health Sciences Center in Denver, Colorado in 1998 and completed his residency training in Emergency Medicine from Denver Health Medical Center in Denver, Colorado in 2002, where he also served as Chief Resident.

  • Medical Editor: Bhupinder S. Anand, MBBS, MD, DPHIL (OXON)
    Bhupinder S. Anand, MBBS, MD, DPHIL (OXON)

    Bhupinder S. Anand, MBBS, MD, DPHIL (OXON)

    Dr. Anand received MBBS degree from Medical College Amritsar, University of Punjab. He completed his Internal Medicine residency at the Postgraduate Institute of medical Education and Research, Chandigarh, India. He was trained in the field of Gastroenterology and obtained the DPhil degree. Dr. Anand is board-certified in Internal Medicine and Gastroenterology.

woman with abdominal pain

What are the causes of an enlarged spleen?

Blood disorders

The spleen will enlarge when it performs more of its duties to filter blood or to manufacture blood cells. Therefore, any disease or condition that damages red blood cells, and requires them to be filtered and removed from the blood stream, will cause the spleen to become larger.

Conditions such as hemolytic anemia, where red blood cells are damaged and broken down (hemolyzed) can cause the spleen to enlarge. Misshapen red blood cells, like those found in sickle cell disease, thalassemia, and spherocytosis, may be damaged when they try to squeeze through small capillary blood vessels. These damaged red blood cells need to be culled from the bloodstream and are filtered out by the spleen.

Decreased blood flow

The spleen will enlarge if there is a decrease in blood flow through the splenic vein. This may cause spleen congestion and enlargement. This situation may be associated with liver disease and portal hypertension. Damage to liver cells makes it difficult for blood to flow normally, and as blood backs up in the portal vein system, it may also affect pressure in the splenic vein. The decreased ability of blood to drain from the spleen causes it to become congested and grow larger. People with congestive heart failure may have an enlarged liver and spleen because of poor blood flow to and from the heart.

Cancer

Leukemia and lymphoma may be associated with abnormal white cells that can invade the spleen and increase its size.

Other cancers can spread or metastasize to the spleen and cause it to enlarge.

Metabolic diseases

Certain metabolic diseases may cause the spleen to enlarge, including Hurler Syndrome, Gaucher disease and Niemann-Pick Disease.

In sarcoidosis and amyloidosis the spleen can be involved and become enlarged with the abnormal protein deposits.

Infection

Some infections may cause splenomegaly including:

Trauma

Trauma, for example, from a car accident, can damage the spleen.

How is the diagnosis of an enlarged spleen made?

An enlarged spleen is most often found on physical examination. Either the health care practitioner is looking for an enlarged spleen because of a diagnosis that has already been made, or it is found incidentally when initially examining a patient (and it then serves as a clue to an underlying diagnosis).

With its location protected beneath the left lower ribs, a normal spleen is usually not felt on physical exam, except in some unusually thin individuals. As it enlarges, the spleen grows from the left upper quadrant of the abdomen towards the umbilicus (the belly button). Sometimes the doctor will ask the patient to roll on their right side to better attempt to feel the spleen. An enlarged spleen may not be felt in obese patients.

On occasion, an enlarged spleen may be diagnosed by plain X-ray, ultrasound, abdominal CT scan, or MRI (magnetic resonance imaging).

Medically Reviewed by a Doctor on 8/12/2015

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