What is Spleen Enlargement (Splenomegaly)? Symptoms and Treatment

by Abbas Jahangir · June 24, 2024

The spleen is an important part of the structure called the lymphatic system in the body. The lymphatic system has functions such as cleaning cellular waste, maintaining fluid balance, and producing and activating immune system cells that fight against diseases. This system also plays an important role in generating the inflammatory response as part of the healing process.

What is Spleen Enlargement?

The spleen is located in the upper left quadrant of the abdomen; It is located inside the rib cage, under the diaphragm and in the upper back part of the stomach. This fist-shaped organ weighs approximately 70-200 grams and is 12 centimeters long in healthy individuals. Measurements above these values may indicate spleen enlargement, referred to as splenomegaly.

Spleen enlargement is defined as an increase in the size of the spleen beyond the normal limits determined by age and gender. Like other parts of the body, the spleen may develop over time. This development process usually continues until adulthood, and after this period, the spleen size gradually decreases.

One of the main functions of the spleen in the human body is to filter blood. The spleen detects old, damaged or abnormal cells in the bloodstream and eliminates them. This organ, which also functions as a warehouse for these cells, can store erythrocytes, which are red blood cells, platelets, which are responsible for blood clotting, and some of the white blood cells that fight against infections.

In addition to its hematological properties, spleen; If it detects bacteria, viruses or other microorganisms that have the potential to cause disease in the bloodstream, it can produce white blood cells (white blood cells) called lymphocytes to eliminate this situation.

The concept of spleen enlargement (splenomegaly) is generally used for a spleen that weighs 400-500 grams and is 12-20 centimeters long. This condition, which usually does not cause any obvious complaints, is detected during routine physical examination. While a normal sized spleen cannot be felt during physical examination, it is an organ that can be easily felt if it enlarges. Apart from physical examination, radiological examinations such as ultrasonography (USG), computed tomography (CT) or magnetic resonance imaging (MRI) can also be used to reveal spleen size.

What are the Symptoms of Spleen Enlargement?

Spleen enlargement is a condition that may occur in some people without causing any symptoms and is noticed during routine physical examinations in healthcare institutions. In some people, the growth of this organ may cause various symptoms due to pressure on surrounding tissues or changes in blood filtering function.

The primary physical symptom associated with spleen enlargement is a vague feeling of abdominal discomfort. People with this condition may describe upper left abdominal pain and left shoulder pain in addition to this symptom. Symptoms such as abdominal bloating, enlargement, malnutrition and early satiety may also be included in the symptom table. The underlying reason for early satiety and feeling of fullness is due to the pressure of the growing spleen on the stomach.

In the presence of symptoms such as extreme fatigue, weight loss and night sweats, care should be taken as the underlying cause of the enlargement of the spleen may be a malignant disease. In spleen enlargement due to an acute (new) onset infectious disease, symptoms such as fever, chills, shivering and general weakness may accompany spleen enlargement.

The spleen, which becomes excessively large over time, may lose control of its filtering function and cause the lysis of many erythrocyte cells. If the number of these cells falls below the sufficient level, it may result in a health problem called anemia . An overgrown spleen also causes problems with immune cell production, and therefore these people may be predisposed to infectious diseases.

The symptoms of spleen enlargement can be generally summarized as follows:

Pain or a feeling of fullness in the left side of the abdomen that may radiate to the left shoulder area
Feeling of fullness before eating or after consuming very small amounts of food
Anemia
Weakness
Getting sick frequently
Predisposition to bleeding

What Causes Spleen Enlargement?

Enlargement of the spleen may occur during the course of many different health conditions and disorders. Infectious diseases such as mononucleosis are among the most common causes of spleen enlargement. Apart from infectious diseases, liver diseases such as cirrhosis or cystic fibrosis can also cause spleen enlargement.

Another possible cause for spleen enlargement is a rheumatic disease that occurs at a young age called juvenile rheumatoid arthritis. This disorder creates a general state of inflammation in the lymph system, including the spleen, and may cause the spleen to increase in size.

There are many different conditions that can be considered as causes of spleen enlargement:

Malaria
Hodgkin’s disease
Leukemia
Heart failure
Cirrhosis
Tumor formations that occur directly on the spleen or in other organs and spread to the spleen from there
Viral, bacterial or parasitic infectious diseases
Inflammatory diseases such as lupus or rheumatoid arthritis
sickle cell anemia

Care should be taken as sickle cell anemia and spleen enlargement may result in “splenic sequestration crisis”, which is a life-threatening condition especially in childhood. In these children, the excessive amount of blood flowing to the enlarged spleen cannot move from the spleen to other organs due to the blockage of the vessels reaching this organ and gets stuck in this area. Then, a sudden drop in the child’s hemoglobin levels may occur, resulting in a state of hypovolemic shock.

How is Splenic Enlargement Diagnosed?

Physicians who suspect spleen enlargement during physical examination can reveal this condition by using various biochemical and radiological tests. Using these tests together is important for both the diagnosis of splenomegaly and revealing the underlying cause. Examining the parameters related to the complete blood count and the structural features of these cells may be useful in predicting the effect of spleen enlargement on the cells in the bloodstream.

Apart from this examination, liver function test, lipase, rheumatological markers or specific tests for the suspected disease, if any, are also considered among the tests that can be used in the diagnosis of spleen enlargement.

The basic radiological examination in evaluating spleen sizes is ultrasonography. Physicians can diagnose splenomegaly by evaluating the anterior and posterior diameter, width and length of the spleen during USG.

Computed tomography (CT), one of the imaging methods, in addition to detecting the increase in the size of the spleen, can also detect abscesses, masses, vascular abnormalities, cystic structures, inflammatory changes, traumatic damage or other abnormalities in this organ.

How is Spleen Enlargement Treated?

The aim of treatment for enlarged spleen is to eliminate the underlying disease and protect the person against conditions related to enlargement of the spleen. People with an enlarged spleen, for whatever reason, are prone to rupture in this organ, and it is important for people to avoid possible trauma to the abdominal area.

Asymptomatic spleen enlargement can be monitored for periods of 6-12 months without intervention if no underlying cause of this condition can be identified. In cases of splenic enlargement that has caused complications or has serious symptoms, surgical removal of the spleen can be performed. Although people can continue their normal lives without this organ after this operation, called splenectomy, it is very important that they be vaccinated against these diseases in the pre- and post-operative period in order to create a predisposition to encapsulated bacterial infections.