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An enlarged spleen, also known as splenomegaly, resides beneath the left rib cage. Various conditions affecting the spleen or the blood flowing through it can lead to its enlargement and swelling. Causes include infections, liver disease, and certain cancers. Some causes are transient, while others may indicate a chronic or progressive issue.
Typically, an enlarged spleen presents no symptoms and is often detected during routine physical examinations. In adults, a healthy spleen is usually not palpable. Imaging and blood tests can aid in determining the cause of splenomegaly.
Treatment for an enlarged spleen depends on its underlying cause. If left untreated, it may eventually malfunction. In rare instances, a significantly enlarged spleen can rupture, resulting in internal bleeding. Though not always necessary, surgical removal of an enlarged spleen is occasionally recommended.
Symptoms
In most cases, an enlarged spleen has no symptoms, but occasionally it can show the following signs and symptoms:
- Pain or bloating in the upper left abdomen that may radiate to the left shoulder.
- A sense of fullness that comes from the spleen pressing on your stomach, either before or after eating a small meal.
- Anemia or low red blood cells.
- Fatigue.
- Frequent cold or infections.
- Easily bleed or bruise.
If you feel discomfort in your left upper abdomen, especially if it’s severe or worsens when you breathe deeply, you should see a healthcare provider immediately.
Causes
An enlarged spleen can be caused by a number of diseases and infections. Frequent causes comprise:
- Infections: The spleen’s immune system is affected by bacterial infections like syphilis, tuberculosis and endocarditis, parasitic infections like malaria and toxoplasmosis, and viral infections like HIV and mononucleosis. They may induce hyperplasia, or the overproduction of immune cells and antibodies.
- Liver diseases: Liver-affected conditions like cirrhosis or chronic hepatitis can lead to portal hypertension, or an increase in pressure in the blood vessels that supply the liver and spleen. Elevated vascular pressure can result in blood pooling and consequent enlargement of the spleen.
- Other diseases:
- Autoimmune diseases: Autoimmune diseases like sarcoidosis, rheumatoid arthritis, or lupus.
- Blood disorder: Conditions like hemolytic anemia and neutropenia, which cause early destruction of red blood cells, can overwhelm the spleen, which is responsible for removing them.
- Cancer: Blood cancers, such as lymphomas, myeloproliferative neoplasms, or leukemia, can invade the spleen with aberrant cells that continue to proliferate.
- Focal lesions: Benign growths like an abscess or cyst, as well as metastatic cancer that spreads from another location.
- Metabolic disorders: Metabolic conditions, like Niemann-Pick and Gaucher diseases.
- Thrombosis: Blood and pressure might build up in your spleen due to a blood clot that obstructs the vessels in your liver or spleen.
Risk factors
An enlarged spleen can occur in anyone at any age, however some populations are more at risk than others. The following risk factors may include:
- Children and young adults who are suffering from infections like mononucleosis.
- Individuals suffering from Niemann-Pick disease, Gaucher disease, and various other hereditary metabolic disorders affecting the spleen and liver
- Individuals who reside in or visit regions where malaria is common
Diagnosis
When you visit a healthcare provider, you might have symptoms related to your underlying condition, or you may experience generalized abdominal discomfort.
The following procedures will assist the healthcare provider in properly diagnosing an enlarged spleen:
- Physical examination: Healthcare providers may incidentally find an enlarged spleen during a routine examination or while investigating other issues. Typically, a physical examination is sufficient to identify an enlarged spleen. Often, healthcare providers can palpate it by gently pressing on the left upper abdomen. However, in some individuals, particularly those who are thin, a physical examination may reveal a healthy, normal-sized spleen.
In order to confirm the diagnosis of an enlarged spleen, your healthcare provider might recommend the following tests: - Blood tests: Your healthcare provider might perform blood tests, such as a complete blood count and liver function tests, to further investigate if they are uncertain about the cause of the enlarged spleen.
- Imaging test: A CT scan or abdominal ultrasound can confirm the presence of an enlarged spleen and provide further details, such as the extent of enlargement, the presence of a lesion, and whether the spleen is invading other organs. You may trace the blood flow through your spleen by an MRI.
- Bone marrow analysis: Your healthcare provider may perform a bone marrow aspiration and/or biopsy to examine the blood cell composition within your bone marrow. This procedure offers insights into the functionality of your spleen and can help identify potential disorders.
Spleen needle biopsies are uncommon due to the possibility for bleeding.
In cases where there is no apparent reason for the enlargement, your healthcare provider may suggest a splenectomy as a diagnostic procedure. The spleen is typically removed as part of treatment. Following the surgical removal of the spleen, it undergoes microscopic examination to screen for potential spleen lymphoma.
Treatment
The spleen often returns to its usual size once the underlying condition improves. Certain conditions, such as temporary infections, may resolve on their own. Your healthcare provider may use medication, blood treatments, or surgery to address further issues.
The goal of treatment for an enlarged spleen is to identify and address its cause. For example, if you have a bacterial infection, antibiotics would be part of the treatment.
If you have an enlarged spleen but no symptoms, and the cause is unknown, your healthcare provider may recommend watchful waiting. You will need to return for a re-assessment in six to twelve months or sooner if you develop symptoms.
- Surgery:
- Spleen removal surgery: A splenectomy—the removal of the enlarged spleen through surgery—may be an option if the enlarged spleen produces significant complications or if the cause cannot be identified or treated. In severe or chronic situations, surgery may be the best course of action for recovery.
Much consideration must be given to elective spleen removal. Without a spleen, one can lead an active life, but after having them removed, the risk of developing severe or life-threatening infections increases. - Preventing the risk of infection after surgery: Following spleen removal, you can prevent or lower your risk of infection by doing the following:
- These vaccines encompass the pneumococcal, meningococcal, and Haemophilus influenzae type b (Hib) vaccines, safeguarding against against pneumonia, meningitis, and infections of the blood, bones, and joints. Additionally, following surgery, you will require the pneumococcal vaccination every five years.
- After surgery and if you or your healthcare provider detects an infection, take penicillin or other antibiotics.
- Seek medical attention if you experience any indication of infection such as fever.
- Stay clear of locations where certain diseases, including malaria, are common.
- Spleen removal surgery: A splenectomy—the removal of the enlarged spleen through surgery—may be an option if the enlarged spleen produces significant complications or if the cause cannot be identified or treated. In severe or chronic situations, surgery may be the best course of action for recovery.
