What Is Splenomegaly?

Lindsay Curtis is a freelance health & medical writer in South Florida. Prior to becoming a freelancer, she worked as a communications professional for health nonprofits and the University of Toronto’s Faculty of Medicine and Faculty of Nursing.

Jay N. Yepuri, MD, MS, FACG, is a board-certified gastroenterologist and member of the Digestive Health Associates of Texas Board of Directors and Executive Committee.

Splenomegaly is an enlarged spleen. Your spleen is an organ in your upper left abdomen, tucked under your rib cage. It's an important part of your lymphatic system and plays a role in immunity. It filters blood, removes old or damaged red blood cells, and produces white blood cells to help fight bacteria and other harmful microorganisms.

Your spleen is usually about the size of your fist, but it can nearly double in size when enlarged. People with splenomegaly often have no symptoms, though some may experience abdominal pain or fullness after eating a small amount of food.

Many conditions can cause splenomegaly, including infections, liver conditions, autoimmune disorders, and blood disorders. Treatment for an enlarged spleen focuses on treating the underlying cause.

Types

Splenomegaly types are classified based on the underlying cause. They include:

• Congestive splenomegaly: Develops due to increased pressure in the portal vein, which carries blood from your digestive organs to your liver. Increased pressure in the portal vein is often caused by liver disease or heart or kidney failure.
• Neoplastic splenomegaly: Caused by the growth of a tumor in the spleen. Tumors can be benign (non-cancerous) or malignant (cancerous).
• Infectious splenomegaly: Develops due to increased immune activity, usually due to foreign invaders like bacteria and viruses. For example, infectious mononucleosis (also known as mono) is a condition that causes symptoms like fatigue, swollen glands, and a sore throat. In the United States, mono is a common cause of splenography in adolescents and young adults.
• Inflammatorysplenomegaly: Caused by autoimmune or inflammatory conditions like rheumatoid arthritis, an autoimmune disease that attacks the joints.
• Infiltrativesplenomegaly: Develops when substances that normally don’t enter the spleen—such as proteins and a form of glucose (sugar) called glycogen—enter the spleen and become trapped there.

Splenomegaly Symptoms

Many people with splenomegaly have no noticeable symptoms. When symptoms develop, they may include:

• Abdominal pain or fullness: The spleen is in the upper left abdomen. An enlarged spleen can cause pain or fullness in this area.
• Early fullness: An enlarged spleen can press on the stomach, causing you to feel full after eating small amounts of food.
• Palpable spleen: Most people can’t feel their spleen by touching under their left rib unless it is enlarged.
• Hiccups: An enlarged spleen can irritate the diaphragm, causing hiccups. Your diaphragm, located under your lungs, is your primary breathing muscle.

If the spleen enlarges to the point that it cannot function properly, you may develop additional symptoms, such as:

• Weakness and fatigue: A malfunctioning spleen can lead to anemia and cause symptoms like weakness, fatigue, and shortness of breath. Anemia is a condition that occurs when your blood has reduced red blood cells or hemoglobin, a protein that helps red blood cells transport oxygen.
• Frequent infections: The spleen produces white blood cells. Fewer white blood cells circulating in your blood can make you more susceptible to infections like colds and the flu.
• Easy bruising and bleeding: One of the spleen’s functions is storing and filtering blood cells. When it stores too many platelets, you may bruise or bleed more easily than usual.

What causes splenomegaly?

Splenomegaly develops in response to an underlying medical condition or problem within the body. Many disorders and diseases can cause an enlarged spleen, including:

• Liver disease: Liver diseases, such as cirrhosis (a condition that causes extreme liver scarring and damage) and chronic hepatitis (liver inflammation), can cause increased pressure in the portal vein. This increased pressure can lead to blood pooling in the spleen, causing it to enlarge.
• Infections: Foreign invaders, such as bacteria and viruses, can trigger the spleen to overproduce immune cells—like white blood cells—and enlarge. Infections that can cause splenomegaly include mononucleosis, malaria (an infectious disease spread by mosquitoes), and tuberculosis (an airborne bacterial infection).
• Autoimmune diseases: Chronic inflammation caused by autoimmune conditions like rheumatoid arthritis and lupus (a condition that attacks multiple body systems) triggers an overactive immune response and can lead to an enlarged spleen.
• Cancer:Blood cancers, such as leukemia and Hodgkin lymphoma, can carry cancer cells to the spleen, where they grow and multiply, leading to an enlarged spleen.
• Metabolic disorders: Inherited metabolic disorders can cause abnormal substances and cells to infiltrate and engorge the spleen. This includes Gaucher disease (a condition in which you lack an enzyme that breaks down lipids, or fats) and Niemann-Pick disease (a group of conditions that cause lipids to build up in the body).
• Thrombosis: A blood clot that blocks blood flow to or from the spleen or liver can cause splenomegaly.
• Blood disorders: Conditions associated with red blood cell destruction can overload and enlarge the spleen. This includes sickle cell anemia (a condition in which some red blood cells are rigid and sticky and have a crescent moon shape) and neutropenia (a condition in which you have a reduced number of neutrophils, a type of white blood cell).

Risk Factors

Anyone can develop splenomegaly, but certain factors can increase your risk, including:

• Recent history of infection, such as mononucleosis
• Personal or family history of splenomegaly, blood clots, liver disease, cancer, blood disorders, or lipid (fat) storage disorders
• Heavy alcohol use
• Intravenous (IV) drug use
• Living in or traveling to tropical areas where malaria is common
  

How is splenomegaly diagnosed?

Splenomegaly is often detected during a physical exam. Unless you are very slender, your spleen is usually not palpable (felt from the outside). With splenomegaly, your healthcare provider may be able to feel your enlarged spleen by gently pressing on your upper left abdomen below your ribcage.

Splenomegaly is diagnosed based on size or weight. Measurements are usually in centimeters (cm) and grams (g).

If healthcare provider suspects you have splenomegaly, they may order tests to confirm the diagnosis and determine the underlying cause. Standard diagnostic tests for splenomegaly include:

• Blood tests: A complete blood count (CBC) and other blood tests can check for infection, anemia, and other markers associated with splenomegaly.
• Imaging tests:Ultrasounds, computed tomography (CT) scans, and magnetic resonance imaging (MRI) scans help healthcare providers visualize the spleen to measure and determine its size. Imaging tests also help look for signs of infection, tumors, and other abnormalities in the spleen and surrounding tissues.
• Bone marrow biopsy: A small sample of bone marrow is removed and examined under a microscope to check for blood disorders and cancers associated with splenomegaly, such as leukemia and lymphoma.
• Liver or spleen biopsy: A small liver or spleen tissue sample is removed and examined under a microscope to check for spleen or liver tumors and liver diseases, such as cirrhosis.

Splenomegaly Treatment

Treatment for splenomegaly focuses on treating the underlying cause. Your spleen should return to its normal size once the underlying cause is treated. For example, if a bacterial infection is causing an enlarged spleen, your healthcare provider may prescribe antibiotics to cure the infection. In time, the size of your spleen should return to normal.

Some conditions associated with splenomegaly are incurable or chronic. Healthcare providers may try certain several treatment options if your enlarged spleen is causing ongoing pain or discomfort or if you're having difficulty getting the nutrients your body needs because you feel full quickly. These treatment options include:

• Low-dose radiation therapy: Radiation therapy can safely and effectively shrink the spleen. Most people with splenomegaly who receive radiation therapy experience a significant reduction in the size of their spleen after just a few sessions.
• Surgery: Removal of the spleen (splenectomy) may be necessary if you experience severe symptoms or if a tumor is causing an enlarged spleen.

Prevention

There is no surefire way to prevent splenomegaly because it's usually a sign of an underlying condition. Managing conditions associated with an increased risk of splenomegaly may help lower the likelihood of developing an enlarged spleen. This may include taking medications, following a special nutrition plan, or seeing your healthcare provider for regular checkups.

If you have splenomegaly, you can protect your spleen and lower the risk of rupture by:

• Avoiding contact sports: Football, hockey, wrestling, and other activities can cause trauma or injury to your abdomen and rupture an enlarged spleen. A ruptured spleen is a medical emergency.
• Seeing your healthcare provider regularly: Your provider can monitor your spleen size and symptoms and adjust your treatment plan as needed.
• Staying up-to-date on your vaccines: Vaccinations help protect you from certain infections that can cause splenomegaly, such as influenza, malaria, and meningitis (a condition that causes inflammation of protective tissue around your brain and spinal cord).
  

Complications

Untreated splenomegaly can lead to complications such as:

• Ruptured spleen: A ruptured spleen is a medical emergency that requires prompt medical attention and treatment. Trauma or injury to the abdomen increases the risk of a ruptured spleen, though it can also occur spontaneously with untreated splenomegaly.
• Anemia: The spleen helps filter and produce red blood cells. An enlarged spleen may not produce enough red blood cells, leading to anemia.
• Increased risk of infection: The spleen plays a vital role in the immune system. An enlarged spleen may not produce sufficient white blood cells, increasing your risk of infection.
  

A Quick Review

Splenomegaly is an enlarged spleen. The spleen plays an important role in the lymphatic and immune systems. Splenomegaly can be asymptomatic, but common symptoms include abdominal pain, hiccups, and feeling full after eating small amounts.

Possible causes of splenomegaly range from acute (temporary) infections to chronic conditions. Treatment varies depending on the underlying cause.

Untreated splenomegaly can increase the risk of infection, anemia, and a ruptured spleen. Contact a healthcare provider if you feel pain in your upper left abdomen, especially if it's severe or worsens when you breathe.

Frequently Asked Questions

Several autoimmune diseases can affect the spleen, including rheumatoid arthritis, systemic lupus erythematosus (SLE), and autoimmune hemolytic anemia. With these conditions, the immune system mistakenly attacks the body’s tissues, leading to inflammation and, in some cases, spleen enlargement (splenomegaly) as a secondary effect.

An enlarged spleen can be serious, but it is not always a cause for alarm. The seriousness of an enlarged spleen often depends on the underlying cause and degree of enlargement. In some cases, splenomegaly may not cause symptoms or only cause mild discomfort. In others, splenomegaly can lead to complications such as a ruptured spleen, anemia, or a weakened immune system.

An enlarged spleen may heal on its own if the cause is temporary. For example, if an infection is causing splenomegaly, the spleen may return to its normal size once the infection is cured. However, if the enlargement is due to a chronic condition like liver disease or a blood disorder, the spleen may not heal without treatments to manage the underlying cause and reduce spleen size.