Significance of splenomegaly in the differential diagnosis of hematologic disorders

• Patient may notice splenomegaly as a dragging sensation in the LUQ and may notice early satiety

• Storage function of spleen may become exaggerated (hypersplenism), leading to anemia, leukopenia, and thrombocytopenia (can be corrected with a splenectomy)

• Spleen pathology

  • Nonspecific acute splenitis

    • May occur with any blood-borne infection

    • Parenchyma is soft and there is acute congestion (hyperemia) of the red pulp

    • Diffuse increase in neutrophils may lead to abscess formation

    • May have foci of necrosis

  • Congestive splenomegaly

    • Blood isn’t leaving the spleen, leading to capsular and parenchymal fibrosis and hemorrhage

    • Causes

      • Systemic venous congestion from RSHF or cor pulmonal following LSHF (size usually < 500 grams)

      • Cirrhosis and resultant portal HTN (can lead to massive splenomegaly)

      • Thrombosis or compression of the extrahepatic portal vein which may be associated with intrahepatic obstructive disease, vascular inflammation, or neoplasms

  • Splenic infarcts

    • From occlusion of splenic artery or its branches

    • Usually from cardiac emboli; septic infarcts may arise from infective endocarditis of left-sided heart valves

    • Also seen in early stages of sickle cell anemia, with progression to total infarction (autosplenectomy)

  • Splenic neoplasms

    • Primary or secondary involvement by lymphoma or leukemia and metastatic carcinomas are most common

    • Primary neoplasms are rare and include fibromas, osteomas, chondromas, lymphangiomas, and hemangiomas

  • Congenital anomalies (unusual that spleen is the only anomaly)

    • Hypoplasia

    • Asplenia (usually associated with situs inversus and cardiac malformations

    • Accessory spleens (spleniculi)

      • Common; come from splenic trauma seeding peritoneum with lymphoid tissue

      • Only significant if all splenic tissue needs to be removed for therapeutic reasons, such as in hereditary spherocytosis, refractory thrombocytopenic purpura, and some causes of hypersplenism

  • Rupture

    • May be traumatic or spontaneous; usually necessitates splenectomy from massive intraperitoneal hemorrhage

    • Spontaneous rupture associated with mono, malaria, typhoid F, leukemia, and acute splenitis

Category: Medical Subject Notes , Pathology Notes