Enlarged spleen (splenomegaly) facts
- An enlarged spleen is not normal and
occurs as a consequence of another underlying disease.
- An enlarged spleen is caused by
- Signs of an enlarged spleen are usually
due to underlying causes and may include
of an enlarged spleen are usually due to the underlying disease or condition
causing it; however, those individuals who do have symptoms may experience
- indigestion and a feeling of fullness because the enlarged
spleen can compress the stomach,
- hiccups because of diaphragm irritation
- pain in the upper abdomen that may radiate to the back or
- Diagnosis of an enlarged spleen is
often made by physical examination or by X-rays, CT scan,
- Treatment for an enlarged spleen is
directed to the care of the underlying condition.
- Enlarged spleen can be prevented by
preventing the underlying illness as best as possible. An enlarged spleen is at
risk for damage when it grows beyond the protection given to it by the lower
ribs. Activity may need to be restricted to prevent any trauma or damage to the
spleen when it is enlarged and vulnerable
- The prognosis of someone with an
enlarged spleen depends upon the underlying condition.
What is the spleen, and what does it do (function)?
The spleen is an important organ in the body that has a variety of responsibilities.
- It is a major filter of blood, helping
remove old and damaged red blood cells, and bacteria.
- It also is part of the lymphatic system
and produces lymphocytes, a type of white blood cell that are a part of the immune
system that helps to prevent and fight infection.
- The spleen also acts as a reservoir for
red blood cells and platelets, should the body need them.
Quick GuideDigestive Disorders: Common Misconceptions
Enlarged Spleen Symptoms
Symptoms you may experience with an enlarged spleen include:
- pressure or pain in the left upper part of your abdomen (near the stomach),
- feeling full without eating a large meal,
- or pain your left shoulder blade or shoulder area when taking a deep breath.
What type of pain, and where is the pain located with an enlarged spleen?
of its location, should it enlarge, the spleen can irritate the diaphragm and
hiccups and perhaps some pain in the left upper quadrant of the abdomen.
- Because its location adjacent to the diaphragm, pain from the spleen may radiate to the back and be felt in the shoulder blade.
- If the enlarged spleen compresses the stomach the person may feel full after eating a
small amount, and therefore are unable to eat large meals.
What are other signs and symptoms of an enlarged spleen?
Often, it is not the enlarged spleen itself that causes symptoms, but rather it is the symptoms of the underlying illness that causes splenomegaly.
Where is the spleen, and what does it look like?
The spleen is located in the left upper quadrant of the abdomen, just beneath the diaphragm and next to the stomach. It has a very rich blood supply since it is responsible for filtering blood, and it is protected by the 9th, 10th, and 11th ribs. Normally, it is the size of an orange or a small fist.
The spleen has two types of tissue; the red pulp is responsible for filtering blood, while the white pulp is responsible for its immune function.
What are the causes of an enlarged spleen?
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.
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.
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.
Some infections may cause splenomegaly including:
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
On occasion, an enlarged spleen may be diagnosed by plain X-ray,
abdominal CT scan, or MRI
(magnetic resonance imaging).
What is the treatment for an enlarged spleen?
Because splenomegaly is due to an underlying illness, treatment will
depend upon the primary cause. In some situations, removal of the spleen
(splenectomy) may be part of the treatment. For example, in hereditary
spherocytosis, misshapen red blood cells are filtered from the blood stream
causing anemia and an enlarged spleen. Splenectomy limits the number of red
blood cells destroyed and helps treat the disease.
What complications are associated with an enlarged spleen?
Perhaps the most important worry with an enlarged spleen is the risk of
injury as it grows beyond the protection of the rib cage. A minor injury may
cause it to rupture and bleed. Spleen injuries are often treated by
observation, but on occasion, the spleen can rupture causing life-threatening
requiring surgery for to remove the spleen. This is the reason that teenagers
and young adults diagnosed with infectious mononucleosis need to wait until the
spleen returns to its normal size, and is protected by the rib cage, before
participating in activities where the enlarged spleen could be damaged.
All types of blood cells may become trapped in a large spleen. Anemia (low
red blood cell count) may cause
Thrombocytopenia (low platelet count) may be associated
with an increased risk of bleeding.
Leukopenia (low white blood cell count) may
be associated with an increased risk of infection.
Should the spleen need to be removed surgically (splenectomy), the risk of certain infections
increases, and the patient will need to make certain
that their immunizations are up to date, especially against
meningococcus and haemophilus influenzae.
Can an enlarged spleen be prevented?
An enlarged spleen is the consequence of an underlying illnesses, many of
which may not be anticipated or prevented.
- Liver disease due to alcohol abuse,
cirrhosis and portal hypertension, can be prevented. With alcohol
use, moderation is the key, and excessive drinking has very dangerous
consequences both in the short and long term.
- Certain causes of
hepatitis B and
hepatitis C), which can lead to cirrhosis also can
be prevented by avoiding contact with body fluids from infected individuals.
Hepatitis B can also be prevented through
infectious diseases such as HIV, malaria, tuberculosis, and anaplasmosis can be
prevented if the appropriate measures are taken to minimize the risks of
acquiring the disease.
What is the prognosis for someone with an enlarged spleen?
Often, the prognosis for an enlarged spleen depends entirely upon the
underlying illness. For example, in patients with infectious mononucleosis, the
spleen will return to its normal size once the infection resolves.
In some instances, the spleen may need to be removed and the risk of
infection may increase. In other cases, the spleen will remain enlarged and
leave the patient at an increased risk for bleeding, spleen rupture, and infection.
Quick GuideDigestive Disorders: Common Misconceptions
Medically Reviewed on 10/12/2016
Medically reviewed by John A. Daller, MD; American Board of Surgery with subspecialty certification in surgical critical care
Hillman,R, etal. "Hematology in Clinical Practice." 5th edition. McGraw Hill Education. 2010
Rakel RE, Rakel DR. Textbook of Family Medicine. 8th edition. Saunders. 2011.