tropical splenomegaly syndrome


[splee-nuh-meg-uh-lee, splen-uh-]
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.

Symptoms and signs

Symptoms may include abdominal pain, early satiety due to splenic encroachment, or the symptoms of anemia due to accompanying cytopenia.

Signs of splenomegaly may include a palpable left upper quadrant abdominal mass or splenic rub. It can be detected on physical examination by using Castell's sign or Traube's space, but an ultrasound can be used to confirm diagnosis.


Splenomegaly grouped on the basis of the pathogenic mechanism
Increased function Abnormal blood flow Infiltration
Removal of defective RBCs spherocytosis
nutritional anemias
early 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
brucellosis, leptospirosis, tuberculosis
malaria, leishmaniasis, trypanosomiasis
Disordered immunoregulation
rheumatoid arthritis
Serum sickness
Autoimmune hemolytic anemia
Immune thrombocytopenia
drug reactions
Extramedullary hematopoiesis
Marrow infiltration by tumors, leukemias
marrow damage by radiation, toxins
Organ Failure
congestive heart failure
hepatic vein obstruction
portal vein obstruction
Budd-Chiari syndrome
splenic vein obstruction

hepatic schistosomiasis
hepatic echinococcosis
Metabolic diseases
Gauchers disease
Niemann-Pick disease
Hurler syndrome and other Mucopolysaccharidoses
Tangier disease
Benign and malignant infiltrations
Leukemias(acute,chronic,lymphoid and myeloid)
lymphomas(Hodgkins and non-hodgkins)
myeloproliferative disorders
metastatic tumors(commonly melanoma)
histiocytosis X
splenic cysts
eosinophilic granuloma

The causes of massive splenomegaly (>1000 g) are much fewer and include:


If the splenomegaly underlies hypersplenism, a splenectomy is indicated and will correct the problem. After splenectomy, however, 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 vaccinations. Long-term prophylactic antibiotics should be given.

See also


External links

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