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Synonyms and keywords: Spleen enlargement; enlarged spleen; spleen swelling

Overview

Splenomegaly is an enlargement of the spleen, which usually lies in the left upper quadrant (LUQ) of the human abdomen. It is one of the four cardinal signs of hypersplenism, the other three being cytopenia(s), normal or hyperplastic bone marrow, and a response to splenectomy. Splenomegaly is usually associated with increased workload (such as in hemolytic anemias), which suggests that it is a response to hyperfunction. It is therefore not surprising that splenomegaly is associated with any disease process that involves abnormal red blood cells being destroyed in the spleen. Other common causes include congestion due to portal hypertension and infiltration by leukemias and lymphomas.

Normal spleen

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Splenomegaly overview from Other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications, and Prognosis

Natural History

Complications

Prognosis

Diagnosis

Diagnostic Criteria

History and Symptoms

Physical Examination

Laboratory Findings

Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

Prevention

References

Editor-In-Chief: Template:Splenomegaly C. Michael Gibson, M.S., M.D. [1]

Pathophysiology

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Overview

Pathophysiology

References

Editor-In-Chief: Template:Splenomegaly C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief:

Causes

The causes of splenomegaly vary widely and range from increased splenic function (such as hemoglobinopathies), splenic congestion due to abnormal blood flow (such as venous obstruction), and splenic infiltration (such as storage disorders and malignancies).

Causes by Pathogenesis

Mechanism	Pathogenesis		Example
Increased function	Removal of defective RBCs		Spherocytosis Thalassemia Hemoglobinopathy Anemia Sickle cell anemia
	Immune hyperplasia	Response to infection (viral, bacterial, fungal, parasitic)	Mononucleosis AIDS Viral hepatitis Subacute bacterial endocarditis Bacterial septicemia Splenic abscess Typhoid fever Leptospirosis Tuberculosis Histoplasmosis Malaria leishmaniasis Trypanosomiasis Ehrlichiosis
		Disordered immunoregulation	Rheumatoid arthritis SLE Serum sickness Autoimmune hemolytic anemia Immune thrombocytopenia Sarcoidosis
		Drug reactions	Cidofovir Filgrastim
	Extramedullary hematopoiesis		Myelofibrosis Tumors Lukemias Marrow damage by radiation toxins
Abnormal blood flow	Organ Failure		Cirrhosis Congestive heart failure
	Vascular		Hepatic vein obstruction Portal vein obstruction Budd-Chiari syndrome Splenic vein obstruction
	Infections		Hepatic schistosomiasis Hepatic echinococcosis
Infiltration	Metabolic diseases		Gauchers disease Niemann-Pick disease Hurler syndrome Mucopolysaccharidoses Amyloidosis Tangier disease
Infiltration	Benign and malignant infiltrations		Leukemias (acute, chronic, lymphoid and myeloid) Lymphomas (Hodgkins and non-hodgkins) Myeloproliferative disorders Metastatic tumors (commonly melanoma) Histiocytosis X Hemangioma Lymphangioma Splenic cyst Hamartomas Eosinophilic granuloma

Differentiating Splenomegaly from Other Diseases

Category	Disease		Etiology	Clinical manifestations												Para−clinical findings										Gold standard	Associated findings
				Demography	History	Symptoms					Signs					Lab Findings									Imaging
						Fever	Fatigue	Weight	Abdominal pain	Bleeding	BP	JVP	Jaundice	Ascites	Other	CBC			Iron	LFT	PT/PTT	BUN/Cr	UA	Histopathology
						Fever	Fatigue	Weight	Abdominal pain	Bleeding	BP	JVP	Jaundice	Ascites	Other	WBC	Hb	Plt	Iron	LFT	PT/PTT	BUN/Cr	UA	Histopathology
Congestive	Cirrhosis^[1]		Infection Alcohol Autoimmune	Any age, more common in elderly	Hepatitis Alcohol use NAFLD	–	+	↑↓	+	+	↓	Nl	+	+	Spider angiomata Palmar erythema Weakness	↓	↓	↓	Nl	↑	↑	↑	Dark urine	Pancytopenia Regenerating nodules of hepatocytes Fibrosis Deposition of connective tissue between these nodules	Small and nodular liver on ultrasound Fibrosis on liver scan	Liver biopsy	Hepatic encephalopathy Gynecomastia Hypogonadism Esophageal varices Caput medusa Dupuytren’s contracture
	Heart failure^[2]		Coronary artery disease HTN	Elderly	Smoking Sedentary lifestyle Obstructive sleep apnea	–	+	↑↓	–	–	↑	↑	±	+	Dyspnea Weakness Chest pain Heart murmur	↓	↓	↑	Nl	↑	↑	↑	Nl	NA	Normal or low ejection fraction on echocardiography Cardiomegaly on chest x-ray	Echocardiography	Pulmonary edema Hyponatremia Elevated BNP
	Thrombosis of portal, hepatic, or splenic veins^[3]		Thrombosis	Any age	Inflammation Infection Cirrhosis Cancer	+	+	↑	+	+	↓	Nl	±	+	Weakness Hematemesis Melena	↓	↓	↓	Nl	↑	↑	↑	Dark urine	NA	Reduced or absent blood flow on doppler ultrasonography	Doppler ultrasonography	Portal hypertension Esophageal varices
Malignancy	Lymphoma^[4]		Unknown Mutation Infection	Any age, most common malignant splenic tumor	Epstein Barr virus Positive family history Smoking HIV Autoimmune diseases	+	+	↓	+	+	Nl	Nl	+	–	Lymphadenopathy Itching Night sweats Anorexia Dyspnea	↓	↓	↓	High ferritin	↑	↑	↑	Nl	Different histopathological features based on types and stages Reed-Sternberg cell Malignant cells	Peritoneal lymphomatosis on CT scan	Lymph node biopsy	Primary immune disorder Post-transplant
	Leukemia^[5]		Unknown Mutation Bone marrowinfiltration Ineffective hematopoiesis Immune mediated	Elderly, male>female	History of hematological disorder History of chemotherapy andionizing radiation	+	+	↓	+	+	Nl	Nl	±	+	Pallor Leukemia cutis Bruising Petechiae Ecchymosis Fatigue Bone tenderness Early satiety	↓	↓	↓	High ferritin	↑	↑	↑	Nl	Leukemic blasts Leukoerythroblastic features Giant platelets	NA	Bone marrow examination + clinical manifestation	Infections of variable severity Cranial nerve palsy
	Polycythemia Vera^[6]		Autonomous erythrocyteproduction JAK2mutation	Mean age >60 years old	Positive family history	–	+	Nl	+	–	Nl	Nl	–	–	Erythromelalgia Chest pain Stroke-like symptoms Pruritus Dizziness Visual disturbance Facial plethora Painful erythema Lymphadenopathy	Nl to ↑	↑	Nl to ↑	High ferritin	Nl	Nl	Nl	Nl	Elevated normochromic, normocytic RBCs Thrombocytosis Rarely immature cells Leukoerythroblastic picture	NA	WHO criteria for PV	Stroke Venous thrombosis Myelofibrosis Acute leukemia
	Disease		Etiology	Demography	History	Fever	Fatigue	Weight loss	Abdominal pain	Bleeding	BP	JVP	Jaundice	Ascites	Other	WBC	Hb	Plt	Iron	LFT	PT/PTT	BUN/Cr	UA	Histopathology	Imaging	Gold standard	Associated findings
	Multiple myeloma^[7]		Unknown Mutation Infection	Any age, more common in adults	Exposure to chemicals Radiation Pre-existent blood disorders	+	+	↓	+	+	Nl	Nl	+	–	Lymphadenopathy Itching Night sweats Anorexia Dyspnea	↓	↓	↓	High ferritin	Nl	↑	↑	Hemoglobinuria	Blast cells		Bone marrow examination	Tumor lysis syndrome Infection CNS involvement DIC
	Essential thrombocythemia^[8]		Acquired mutation of JAK2, CALR, or MPL	Mean age >60 years old, female > male	Vascular occlusive events and hemorrhages	±	+	Nl	+	+	Nl	Nl	–	–	Flushing Erythromelalgia Transient ischemic attacks Priapism Decreased visual acuity	↑	↑	↑↑	Nl	Nl	Nl	Nl	Nl	Increased cellularity Hyperplasia and clustering of megakaryocytes Bone marrow reticulin may be increased with no collagen fibrosis	Splenomegaly on abdominal CT VTE on spiral chest CT DVT on ultrasound	Bone marrow biopsy	Thrombosis
	Primary myelofibrosis^[9]		Bone marrow fibrosis Mutation in JAK2, CALR, or MPL	Mean age >60 years old, male> female	Other myeloproliferativedisorders Radiation exposure Chemicals exposure	–	+	Nl	+	+	Nl	Nl	+	–	Pallor Bruising Skin nodules Insert paragraph Fatigue Abdominal pain Early satiety Dyspnea Lymphadenopathy	↓	↓	↑/↓	Low iron	Nl	↑	Nl	Dark urine	Proliferation and atypia of megakaryocytes Reticulin or collagen fibrosis Hypercellular bone marrow	Diffuse bone sclerosis on CT	Bone marrow biopsy	Thrombosis Variable risk for development of acute leukemia
	Primary splenic tumors^[10]		Lymphoid neoplasms Vascular neoplasms	Very rare	Positive family history	+	+	↓	+	–	Nl	Nl	–	–	Lymphadenopathy Dyspnea Shoulder pain Constipation Cachexia Pleural effusion	↓	↓	↓	Low iron, low ferritin	↑	↑	↑	Dark urine	Different histopathologic features depends on the type of tumor	Heterogeneous mass in the spleen on ultrasound Lymphomatous nodules and masses on CT scan	Biopsy	Metastasis to liver Poor prognosis
	Metastatic solid tumors^[11]		Bone marrowinfiltration Ineffective hematopoiesis Immune mediated	Any age, more in adults	Exposure to chemicals Radiation Pre-existent blood disorders	+	+	↓	+	+	↓	Nl	±	±	Petechiae Weakness	↓	↓	↓	Low iron, high ferritin	↑	↑	↑	Dark urine	Blast cells		Biopsy	Tumor lysis syndrome Infection CNS involvement DIC
	Disease		Etiology	Demography	History	Fever	Fatigue	Weight	Abdominal pain	Bleeding	BP	JVP	Jaundice	Ascites	Other	WBC	Hb	Plt	Iron	LFT	PT/PTT	BUN/Cr	UA	Histopathology	Imaging	Gold standard	Associated findings
Infection	Viral	Hepatitis^[12]	Infection Autoimmune	Any age	High risk behaviors Close contact	+	+	↓	+	+	Nl	Nl	+	+	Lymphadenopathy Muscle weakness Joint swelling Focal neurologic signs Depends on etiology	↓	↓	↓	Nl	↑	↑	↑	Dark urine Hematuria	Pancytopenia	NA	Clinical manifestation + lab tests	Depends on etiology Encephalomyelitis
		Infectious mononucleosis^[13]	EBV	More common in children and young adults	Close contact	+	+	Nl	+	–	Nl	Nl	+	–	Sore throat Enlarged tonsils Lymphadenopathy Headache Maculopapular rash on the arms or trunk	↑	Nl	↑	Nl	↑	Nl	Nl	Nl	NA	NA	Clinical manifestation + heterophile antibody test	Splenic rupture Lymphocytosis Seizures
		Cytomegalovirus^[14]	CMV	More common in: Immunocompromised patients During pregnancy	Close contact	+	+	Nl	+	–	Nl	Nl	+	–	Exudative pharyngitis Symmetrical cervical adenopathy	↑	Nl	↑	Nl	↑	Nl	Nl	Nl	NA	NA	ELISA
	Bacterial	Salmonella^[15]	Salmonella	Any age	Eating contaminated meat, eggs, or milk	+	–	Nl	+	–	↓	Nl	–	–	Diarrhea Abdominal cramps Vomiting Dehydration	↑	Nl	↑	Nl	Nl	Nl	↑	Oliguria	NA	NA	Stool test	Typhoid fever Reactive arthritis Irritable bowel syndrome
		Brucella^[16]	Brucella	Any age	Ingesting contaminated food such as unpasteurized milk products Direct contact with an infected animal Inhalation of aerosols	+	+	Nl	+	–	↓	Nl	+	–	Headache Vomiting Diarrhea Constipation Arthralgia Night sweats Anorexia Foul-smelling perspiration	↑	Nl	↑	Nl	↑	Nl	Nl	Oliguria	NA	NA	Blood culture	Arthritis Epididymo-orchitis Spondylitis Neurobrucellosis Liver abscess formation Endocarditis
		Tuberculosis^[17]	Mycobacterium tuberculosis	Any age More common in developing countries and among immunocompromised patients	Close contact HIV	+	+	↓	+	–	↓	Nl	+	–	Chronic cough with blood-containing sputum Night sweats Anorexia Chest pain	↑	Nl	↑	Nl	↑	↑	↑	Oliguria	Acid-fast bacillus	Cavity on chest x ray	Identifying M. tuberculosis in a clinical sample	Tuberculous meningitis Urogenital tuberculosis Pott disease Miliary tuberculosis
	Parasitic	Malaria^[18]	Plasmodium	Worldwide More common in tropical and subtropical regions	Bitten by Anopheles mosquito	+	+	Nl	+	+	↓	Nl	+	–	Flu-like symptoms Headache Shivering Joint pain Vomiting	↑	↓	↑	Nl	↑	Nl	↑	Hemoglobinuria		NA
	Parasitic	Kala-azar^[19]	Leishmania	Any age	Bitten by sandflies	+	+	↓	+	+	↓	Nl	+	+	Asymptomatic Tender spleen Hepatomegaly	↓	↓	↓	Nl	↑	↑	↑	Hemoglobinuria	Visualization of the characteristic amastigote in smears or tissue	NA	Culture	Could be fatal
	Disease		Etiology	Demography	History	Fever	Fatigue	Weight	Abdominal pain	Bleeding	BP	JVP	Jaundice	Ascites	Other	WBC	Hb	Plt	Iron	LFT	PT/PTT	BUN/Cr	UA	Histopathology	Imaging	Gold standard	Associated findings
Inflammation	Sarcoidosis^[20]		Immune mediated Unknown	Autoimmune disease More common in young African American women	Positive family history	+	+	↓	+	+	Nl	Nl	–	–	Bilateral hilar adenopathy Blurry vision Shortness of breath Cough Erythema nodosum	↑	↓	↑	Nl	Nl	Nl	Nl	Nl	NA	Bilateral hilar adenopathy on chest x-ray	Diagnosis of exclusion	Interstitial lung disease Systemic inflammatorydisease
	Serum sickness^[21]		Immune complex hypersensitivity (type III) to certain medications	Any age	Consumption of certain medications	+	+	Nl	+	–	↓	Nl	–	–	Rashes Itching Facial swelling Arthralgia Lymphadenopathy Dyspnea	↓ or ↑ Eosinophilia	↓	↑	Nl	Nl	Nl	↑	Proteinuria Hematuria	Plasma cells on peripheral blood smear Numerous histological changes including inflammation of arterial wall or fibrosis	NA	Clinical manifestation + recent medication consumption	Glomerulonephritis Shock
	Systemic lupus erythematosus^[22]		Immune mediated bone marrow failure	More common in young females	Positive family history	+	+	↓	+	+	Nl to ↓	Nl	+	+	Skin rash Mouth ulcers Chest pain Lymphadenopathy	↓	↓	↓		↑	↑	↑	Hemoglobinuria Proteinuria	Hypocellular bone marrow		Clinical findings + laboratory studies	Multi organ damage
	Felty syndrome^[23]		Immune mediated bone marrow failure	Rare autoimmune disease More common in females 50-70 years old	History of rheumatoid arthritis	+	+	↓	+	+	Nl to ↓	Nl	+	+	Pallor Skin hyperpigmentation Painful, stiff, and swollen joints Keratoconjunctivitis sicca	↓	↓	↓	Nl	Nl	Nl	Nl	Nl	Hypocellular bone marrow		Clinical findings + laboratory studies	Rheumatoid arthritis Infections
Infiltrative	Disease		Etiology	Demography	History	Fever	Fatigue	Weight	Abdominal pain	Bleeding	BP	JVP	Jaundice	Ascites	Other	WBC	Hb	Plt	Iron	LFT	PT/PTT	BUN/Cr	UA	Histopathology	Imaging	Gold standard	Associated findings
	Gaucher disease^[24]		Accumulation of glucocerebroside	Autosomal recessive hereditary deficiency of the enzyme glucocerebrosidase More in Ashkenazi Jews	Positive family history	–	+	↓	+	+	Nl to ↓	Nl	+	+	Painful bone lesions Lymphadenopathy Yellowish-brown skin pigmentation	↓	↓	↓	Nl	Nl	↑	↑	Proteinuria Hematuria	Hypocellular bone marrow	NA	Enzyme testing	The most common of the lysosomal storage diseases Severe neurological complications Infections Osteoporosis
	Niemann-Pick disease^[25]		Mutations in the SMPD1 gene Deficiency in the activity of the lysosomal enzyme acid sphingomyelinase Accumulation of sphingomyelin	Autosomal recessive lysosomal storage disease More common in Ashkenazi Jews	Positive family history	–	+	↑	+	+	Nl to ↓	Nl	+	+	Unsteady gait Slurred speech Dysphagia Dystonia	↓	↓	↓	Nl	↑	↑	↑	Proteinuria Hematuria	Hypocellular bone marrow	NA	Genetic testing	CNS involvement Supranuclear gaze palsy Dementia Seizure Gelastic cataplexy Pulmonary infections Splenic rupture Coronary artery or valvular heart disease
	Langerhans cell histiocytosis^[26]		Clonal proliferation of Langerhans cells	Any age More common in children between 5-10 years old Boys>girls	–	–	+	↓	+	–	Nl	Nl	+	–	Painful bone swelling Scaly erythematous lesions Lymphadenopathy Cough Dyspnea	↓	↓	↓	Nl	↑	↑	↑	Proteinuria Hematuria	Birbeck granules on electron microscopy	Osteolytic lesions on imaging Lung nodules on imaging	Tissue biopsy	Diabetes insipidus
Category	Disease		Etiology	Demography	History	Fever	Fatigue	Weight	Abdominal pain	Bleeding	BP	JVP	Jaundice	Ascites	Other	WBC	Hb	Plt	Iron	LFT	PT/PTT	BUN/Cr	UA	Histopathology	Imaging	Gold standard	Associated findings

Diagnosis

Treatment

If the splenomegaly underlies hypersplenism, a splenectomy is indicated and it will correct the problem. After splenectomy, patients have an increased risk for infectious diseases. After splenectomy, patients should be vaccinated against Haemophilus influenzae and Streptococcus pneumoniae. They should receive annual influenza vaccination. Long-term prophylactic antibiotic should be given.

References

↑ Wu Z, Zhou J, Pankaj P, Peng B (December 2012). “Laparoscopic and open splenectomy for splenomegaly secondary to liver cirrhosis: an evaluation of immunity”. Surg Endosc. 26 (12): 3557–64. doi:10.1007/s00464-012-2366-5. PMID 22710653.
↑ Gedela M, Khan M, Jonsson O (September 2015). “Heart Failure”. S D Med. 68 (9): 403–5, 407–9. PMID 26489162.
↑ Ferri PM, Ferreira AR, Fagundes ED, Liu SM, Roquete ML, Penna FJ (2012). “Portal vein thrombosis in children and adolescents: 20 years experience of a pediatric hepatology reference center”. Arq Gastroenterol. 49 (1): 69–76. PMID 22481689.
↑ Ishibashi N, Maebayashi T, Aizawa T, Sakaguchi M, Abe O, Saito T, Tanaka Y (May 2015). “Myelosuppression toxicity of palliative splenic irradiation in myelofibrosis and malignant lymphoma”. Hematology. 20 (4): 203–7. doi:10.1179/1607845414Y.0000000192. PMID 25131182.
↑ Quest GR, Johnston JB (December 2015). “Clinical features and diagnosis of hairy cell leukemia”. Best Pract Res Clin Haematol. 28 (4): 180–92. doi:10.1016/j.beha.2015.10.017. PMID 26614896.
↑ Chou YS, Gau JP, Yu YB, Pai JT, Hsiao LT, Liu JH, Hong YC, Liu CY, Yang CF, Chen PM, Chiou TJ, Tzeng CH (March 2013). “Leukocytosis in polycythemia vera and splenomegaly in essential thrombocythemia are independent risk factors for hemorrhage”. Eur. J. Haematol. 90 (3): 228–36. doi:10.1111/ejh.12064. PMID 23281576.
↑ Grieco A, Manna R, Mancini R, Gambassi G (April 1988). “Massive hepatomegaly following splenectomy for myeloid metaplasia”. Am. J. Med. 84 (4): 797. PMID 3400674.
↑ Tefferi A, Barbui T (February 2015). “Polycythemia vera and essential thrombocythemia: 2015 update on diagnosis, risk-stratification and management”. Am. J. Hematol. 90 (2): 162–73. doi:10.1002/ajh.23895. PMID 25611051.
↑ Cervantes F, Martinez-Trillos A (May 2013). “Myelofibrosis: an update on current pharmacotherapy and future directions”. Expert Opin Pharmacother. 14 (7): 873–84. doi:10.1517/14656566.2013.783019. PMID 23514013.
↑ Adachi K, Ui M, Nojima H, Takada Y, Enatsu K (August 2011). “Isolated splenic peliosis presenting with giant splenomegaly and severe coagulopathy”. Am. J. Surg. 202 (2): e17–9. doi:10.1016/j.amjsurg.2010.10.002. PMID 21810495.
↑ Huprikar NA, Kurtz MT, Mount CA (October 2013). “Massive splenomegaly and lymphopenia: a unique case of obstructive shock”. BMJ Case Rep. 2013. doi:10.1136/bcr-2013-201643. PMC 3822246. PMID 24172780.
↑ Kumar KJ, Kumar HC, Manjunath VG, Anitha C, Mamatha S (January 2014). “Hepatitis A in children- clinical course, complications and laboratory profile”. Indian J Pediatr. 81 (1): 15–9. doi:10.1007/s12098-013-1114-8. PMID 23904062.
↑ Gao LW, Xie ZD, Liu YY, Wang Y, Shen KL (February 2011). “Epidemiologic and clinical characteristics of infectious mononucleosis associated with Epstein-Barr virus infection in children in Beijing, China”. World J Pediatr. 7 (1): 45–9. doi:10.1007/s12519-011-0244-1. PMID 21191775.
↑ Smiechura M, Strużycka M, Konopka W (2014). “Congenital and acquired cytomegalovirus infection and hearing evaluation in children”. Otolaryngol Pol. 68 (6): 303–7. doi:10.1016/j.otpol.2014.04.003. PMID 25308607.
↑ Rosche KL, Aljasham AT, Kipfer JN, Piatkowski BT, Konjufca V (2015). “Infection with Salmonella enterica Serovar Typhimurium Leads to Increased Proportions of F4/80+ Red Pulp Macrophages and Decreased Proportions of B and T Lymphocytes in the Spleen”. PLoS ONE. 10 (6): e0130092. doi:10.1371/journal.pone.0130092. PMC 4466801. PMID 26068006.
↑ Roset MS, Ibañez AE, de Souza Filho JA, Spera JM, Minatel L, Oliveira SC, Giambartolomei GH, Cassataro J, Briones G (2014). “Brucella cyclic β-1,2-glucan plays a critical role in the induction of splenomegaly in mice”. PLoS ONE. 9 (7): e101279. doi:10.1371/journal.pone.0101279. PMC 4077732. PMID 24983999.
↑ Chandni R, Chandni R, Chandni R (2016). “Extra pulmonary tuberculosis presenting as fever with massive splenomegaly and pancytopenia”. IDCases. 4: 20–2. doi:10.1016/j.idcr.2016.02.005. PMC 4802818. PMID 27051579.
↑ Sumbele IU, Bopda OS, Kimbi HK, Ning TR, Nkuo-Akenji T (November 2015). “Influence of Plasmodium gametocyte carriage on the prevalence of fever, splenomegaly and cardiovascular parameters in children less than 15 years in the Mount Cameroon area: cross sectional study”. BMC Infect. Dis. 15: 547. doi:10.1186/s12879-015-1290-4. PMC 4661959. PMID 26612502.
↑ Sayyahfar S, Ansari S, Mohebali M, Behnam B (April 2014). “Visceral leishmaniasis without fever in an 11-month-old infant: a rare clinical feature of Kala-azar”. Korean J. Parasitol. 52 (2): 189–91. doi:10.3347/kjp.2014.52.2.189. PMC 4028457. PMID 24850963.
↑ Modaresi Esfeh J, Culver D, Plesec T, John B (March 2015). “Clinical presentation and protocol for management of hepatic sarcoidosis”. Expert Rev Gastroenterol Hepatol. 9 (3): 349–58. doi:10.1586/17474124.2015.958468. PMID 25473783.
↑ Chiong FJ, Loewenthal M, Boyle M, Attia J (December 2015). “Serum sickness-like reaction after influenza vaccination”. BMJ Case Rep. 2015. doi:10.1136/bcr-2015-211917. PMC 4691861. PMID 26677148.
↑ Yu C, Gershwin ME, Chang C (2014). “Diagnostic criteria for systemic lupus erythematosus: a critical review”. J. Autoimmun. 48-49: 10–3. doi:10.1016/j.jaut.2014.01.004. PMID 24461385.
↑ Huang T, Liu M, Xu G (January 2014). “Felty’s syndrome with hyperthyroidism: a case report and literature review”. Int J Rheum Dis. 17 (1): 122–4. doi:10.1111/1756-185X.12117. PMID 24472276.
↑ Ayto R, Hughes DA (2013). “Gaucher disease and myeloma”. Crit Rev Oncog. 18 (3): 247–68. PMID 23510067.
↑ Vanier MT (2013). “Niemann-Pick diseases”. Handb Clin Neurol. 113: 1717–21. doi:10.1016/B978-0-444-59565-2.00041-1. PMID 23622394.
↑ DiCaprio MR, Roberts TT (October 2014). “Diagnosis and management of langerhans cell histiocytosis”. J Am Acad Orthop Surg. 22 (10): 643–52. doi:10.5435/JAAOS-22-10-643. PMID 25281259.

[pmid22710653-1] Wu Z, Zhou J, Pankaj P, Peng B (December 2012). “Laparoscopic and open splenectomy for splenomegaly secondary to liver cirrhosis: an evaluation of immunity”. Surg Endosc. 26 (12): 3557–64. doi:10.1007/s00464-012-2366-5. PMID 22710653.

[pmid26489162-2] Gedela M, Khan M, Jonsson O (September 2015). “Heart Failure”. S D Med. 68 (9): 403–5, 407–9. PMID 26489162.

[pmid22481689-3] Ferri PM, Ferreira AR, Fagundes ED, Liu SM, Roquete ML, Penna FJ (2012). “Portal vein thrombosis in children and adolescents: 20 years experience of a pediatric hepatology reference center”. Arq Gastroenterol. 49 (1): 69–76. PMID 22481689.

[pmid25131182-4] Ishibashi N, Maebayashi T, Aizawa T, Sakaguchi M, Abe O, Saito T, Tanaka Y (May 2015). “Myelosuppression toxicity of palliative splenic irradiation in myelofibrosis and malignant lymphoma”. Hematology. 20 (4): 203–7. doi:10.1179/1607845414Y.0000000192. PMID 25131182.

[pmid26614896-5] Quest GR, Johnston JB (December 2015). “Clinical features and diagnosis of hairy cell leukemia”. Best Pract Res Clin Haematol. 28 (4): 180–92. doi:10.1016/j.beha.2015.10.017. PMID 26614896.

[pmid23281576-6] Chou YS, Gau JP, Yu YB, Pai JT, Hsiao LT, Liu JH, Hong YC, Liu CY, Yang CF, Chen PM, Chiou TJ, Tzeng CH (March 2013). “Leukocytosis in polycythemia vera and splenomegaly in essential thrombocythemia are independent risk factors for hemorrhage”. Eur. J. Haematol. 90 (3): 228–36. doi:10.1111/ejh.12064. PMID 23281576.

[pmid3400674-7] Grieco A, Manna R, Mancini R, Gambassi G (April 1988). “Massive hepatomegaly following splenectomy for myeloid metaplasia”. Am. J. Med. 84 (4): 797. PMID 3400674.

[pmid25611051-8] Tefferi A, Barbui T (February 2015). “Polycythemia vera and essential thrombocythemia: 2015 update on diagnosis, risk-stratification and management”. Am. J. Hematol. 90 (2): 162–73. doi:10.1002/ajh.23895. PMID 25611051.

[pmid23514013-9] Cervantes F, Martinez-Trillos A (May 2013). “Myelofibrosis: an update on current pharmacotherapy and future directions”. Expert Opin Pharmacother. 14 (7): 873–84. doi:10.1517/14656566.2013.783019. PMID 23514013.

[pmid21810495-10] Adachi K, Ui M, Nojima H, Takada Y, Enatsu K (August 2011). “Isolated splenic peliosis presenting with giant splenomegaly and severe coagulopathy”. Am. J. Surg. 202 (2): e17–9. doi:10.1016/j.amjsurg.2010.10.002. PMID 21810495.

[pmid24172780-11] Huprikar NA, Kurtz MT, Mount CA (October 2013). “Massive splenomegaly and lymphopenia: a unique case of obstructive shock”. BMJ Case Rep. 2013. doi:10.1136/bcr-2013-201643. PMC 3822246. PMID 24172780.

[pmid23904062-12] Kumar KJ, Kumar HC, Manjunath VG, Anitha C, Mamatha S (January 2014). “Hepatitis A in children- clinical course, complications and laboratory profile”. Indian J Pediatr. 81 (1): 15–9. doi:10.1007/s12098-013-1114-8. PMID 23904062.

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Health Dictionary

Hypersplenism

Introduction

Overview

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Splenomegaly overview from Other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications, and Prognosis

Natural History

Complications

Prognosis

Diagnosis

Diagnostic Criteria

History and Symptoms

Physical Examination

Laboratory Findings

Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

Prevention

References

Pathophysiology

Overview

Pathophysiology

References

Causes

Causes by Pathogenesis

Differentiating Splenomegaly from Other Diseases

Diagnosis

Treatment

References