Enlarged Spleen: Causes, Symptoms, and Treatments

Written by Annie Stuart

Medically Reviewed by Poonam Sachdev on April 25, 2023

• Causes of an Enlarged Spleen
• Symptoms of an Enlarged Spleen
• Treatments for an Enlarged Spleen

What is the spleen and what causes an enlarged spleen (splenomegaly)?

The spleen sits under your rib cage in the upper left part of your abdomen toward your back. It is an organ that is part of the lymph system and works as a drainage network that defends your body against infection.

White blood cells produced in the spleen engulf bacteria, dead tissue, and foreign matter, removing them from the blood as blood passes through it. The spleen also maintains healthy red and white blood cells and platelets; platelets help your blood clot. The spleen filters blood, removing abnormal blood cells from the bloodstream.

The spleen is part of the lymph system and works as a drainage network that defends your body against infection. It is normally about the size of your fist.

A spleen is normally about the size of your fist. A doctor usually can’t feel it during an exam. But diseases can cause it to swell and become many times its normal size. Because the spleen is involved in many functions, many conditions may affect it.

An enlarged spleen is not always a sign of a problem. When a spleen becomes enlarged, though, it often means it has been doing its job but has become overactive. For example, sometimes the spleen is overactive in removing and destroying blood cells. This is called hypersplenism. It can happen for many reasons, including problems with too many platelets and other disorders of the blood.

An enlarged spleen can be caused by infections, cirrhosis and other liver diseases, blood diseases characterized by abnormal blood cells, problems with the lymph system, or other conditions.

Here are some common causes of an enlarged spleen:

Infections

• Viral infections, such as mononucleosis
• Parasitic infections, such as toxoplasmosis
• Bacterial infections, such as endocarditis (an infection of your heart’s valves)

Cancer

• Leukemia, a cancer in which white blood cells displace normal blood cells
• Lymphoma, a cancer of lymph tissue, such as Hodgkin’s disease

Other causes of an enlarged spleen include:

• Inflammatory diseases such as sarcoidosis, lupus, and rheumatoid arthritis
• Trauma, such as an injury during contact sports
• Cancer that has spread (metastasized) to the spleen
• A cyst, a noncancerous fluid-filled sac
• A large abscess, a pus-filled cavity usually caused by a bacterial infection
• Infiltrative diseases such as Gaucher disease, amyloidosis, or glycogen storage diseases

Most people don’t know they have an enlarged spleen because symptoms are rare. People usually find out about it during a physical exam. These are the most common symptoms of an enlarged spleen:

• Being unable to eat a large meal.
• Feeling discomfort, fullness, or pain on the upper left side of the abdomen; this pain may spread to your left shoulder.

If you have pain that is severe or gets worse when taking a deep breath, see your doctor right away.

If you have an enlarged spleen, you may develop other signs or symptoms, too. These are related to the underlying disease. They may include signs and symptoms such as:

• Fatigue
• Weight loss
• Frequent infections
• Easy bleeding
• Jaundice
• Anemia

Your doctor will ask you questions and do a physical exam to diagnose an enlarged, painful spleen. This involves palpating (examining by touch) your spleen. You will also likely need diagnostic tests to confirm the cause of the swollen spleen. These may include blood tests, an ultrasound, or computerized tomography (CT) scan. In some cases, other tests may be needed.

Limit any activities that could rupture your spleen, such as contact sports. A ruptured spleen can cause lots of blood loss and be life threatening. It’s important to seek treatment for the cause of your enlarged spleen. Left untreated, an enlarged spleen can lead to serious complications. In most cases, treatment of the underlying cause of the enlarged spleen can prevent removal of the spleen. In some cases, the spleen will need to be removed surgically (splenectomy).

If surgery is needed, a surgeon is likely to remove the spleen using laparoscopy rather than open surgery. This means the surgery is performed through small incisions. A laparoscope allows the surgeon to view and remove the spleen.

If your spleen is removed, you cannot effectively clear certain bacteria from your body and will be more vulnerable to certain infections. So vaccines or other medications are needed to prevent infection.

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Splenomegaly (enlarged spleen): Causes, symptoms, and treatments

The spleen acts as part of the immune system by filtering blood. Splenomegaly occurs when the spleen grows larger or becomes heavier.

Healthcare professionals consider splenomegaly when the spleen is anywhere from 12 to 20 centimeters (cm) (4.7 to 7.9 inches [in]) in length and weighs more than 400 grams (g) (0.88 pounds [lb]).

Massive splenomegaly occurs when the spleen is larger than 20 cm (7.9 in) or weighs more than 1,000 g (2.2 lb).

This article will discuss some potential causes and symptoms of splenomegaly, as well as the treatment options currently available.

Some of the most common causes of splenomegaly include:

• Blood-related disorders: Conditions such as leukemia, lymphoma, or myeloproliferative conditions can cause cancer cells to invade the spleen and multiply rapidly, thereby increasing the spleen’s size. An estimated 64% of massive splenomegaly cases are due to blood-related disorders.
• Liver diseases: Liver diseases such as cirrhosis or hepatitis can cause increased pressure in the liver that backs up to the spleen. As a result, the spleen starts to enlarge. Hepatosplenomegaly occurs when enlargement and swelling affect both the liver and the spleen.
• Spleen infections: Because the spleen is part of the immune system, infections such as mononucleosis, tuberculosis, bacterial endocarditis, or HIV can cause the spleen to enlarge.

Some less common causes of splenomegaly include:

• connective tissue disorders, including systemic lupus erythematosus and rheumatoid arthritis
• cytopenias, such as autoimmune hemolytic anemia or immune thrombocytopenia purpura
• infiltrative disorders, such as amyloidosis or sarcoidosis
• splenic congestion, including congestive heart failure and portal hypertension
• splenic sequestration, which includes conditions such as pediatric sickle cell disease and hemolytic anemias
• venous thrombosis, such as hepatic or portal vein thrombosis
• rare conditions, including Banti’s syndrome and wandering spleen

Regardless of the cause, splenomegaly is a rare condition. An estimated 2% of the population experiences splenomegaly in their lifetime.

Older individuals are slightly more at risk of developing the condition because the outer covering of the spleen, known as the capsule, becomes slightly thinner with age.

Splenomegaly may not always cause symptoms. However, if symptoms do occur, they may include:

• abdominal bloating
• feelings of abdominal fullness, even after eating only a small amount
• frequent infections
• anemia
• fatigue
• discomfort or pain around the left ribs
• bleeding easily

However, the symptoms of splenomegaly often depend upon the underlying cause. For example, a person with splenomegaly related to cancer may experience:

• night sweats
• unexplained weight loss
• weakness

However, a person who has splenomegaly related to an infection may experience different symptoms altogether. These may include:

• fever
• a general feeling of being unwell (malaise)
• shaking

Meanwhile, a person with splenomegaly related to a blood disorder can have symptoms that include:

• easy bleeding
• easy bruising
• lightheadedness
• shortness of breath

A doctor will consider a person’s symptoms along with any known underlying medical conditions.

In most circumstances, a person cannot feel their spleen. However, a doctor may be able to feel an enlarged spleen just under the left side of the ribs.

To diagnose splenomegaly, a doctor will start by having the person describe their symptoms. They will also perform a physical examination to see whether or not they can feel an enlarged spleen.

A doctor who suspects splenomegaly will likely order laboratory and imaging tests. Some examples of these tests include:

• A complete blood count: This includes measurements of white and red blood cells and platelets. Having low counts of these three measurements may indicate splenomegaly.
• Imaging studies: Typically, these will include CT scans and ultrasounds.
• Liver function tests: Having high levels of liver enzymes such as AST and ALT may suggest splenomegaly.

Again, the tests a doctor orders may depend on the potential underlying cause.

Because other medical conditions tend to cause splenomegaly, treatment will usually start with addressing the underlying condition. For example, a person with splenomegaly related to sickle cell anemia will require blood transfusions or blood exchange transfusions.

In some cases, such as a rupture or cancer, a surgeon may have to remove a person’s spleen in a procedure known as splenectomy. Like the gallbladder or appendix, a person can live without their spleen. However, because the spleen contains so much blood, this type of surgery can be high risk due to excessive bleeding concerns.

While undergoing treatment for the underlying condition, a person should be very careful to avoid sustaining abdominal injuries. Trauma to an enlarged spleen can easily cause the spleen to rupture, which can lead to life threatening bleeding. For example, a person should avoid playing contact sports when they have splenomegaly to reduce their risk of injury.

Splenomegaly can lead to rupture of the spleen. This results in the need for surgery and often blood transfusions to restore blood volumes.

If a person has their spleen removed, they have a higher risk of some infection types. These include Streptococcus pneumoniae and Neisseria meningitidis.

The spleen usually carries immune cells that can help fight such illnesses. However, people who undergo splenectomy may require stronger antibiotics to fight infections than a person who has not had this surgery.

A person should see their doctor if they have any symptoms associated with splenomegaly — such as abdominal symptoms they cannot explain, including swelling, pain, or appetite loss — or can feel their spleen on their left side.

If a person has a known condition that leads to splenomegaly, they should be aware of the potential symptoms and call their doctor if they experience any of them.

Splenomegaly is a rare but potentially life threatening occurrence that can lead to splenic rupture.

The condition can develop due to several underlying medical conditions, ranging from blood disorders to liver disease.

If a person suspects that they have splenomegaly, they should see their doctor and take steps to protect against abdominal injury.

Spleen enlargement: why it is dangerous

Very often the question is asked, what is the reason for the enlargement of the spleen, what is the danger of such a violation. There are no unnecessary organs in the human body. Each of them has its own important functions. The spleen is needed in order for metabolic processes to occur correctly, it regulates hematopoiesis, cleanses the blood of bacteria, and is responsible for the level of its coagulability. This organ works in close connection with others, so the spleen enlarges when they function incorrectly. The spleen is especially clearly affected by disturbances in the functioning of the liver, its enlargement is one of the symptoms of such a serious disease as cirrhosis. The most common causes of cirrhosis are viral hepatitis B and C, fatty liver disease, and alcoholic liver disease. In these diseases, hepatocytes are replaced by fat cells or connective tissue. Gradually, the liver ceases to perform its functions, which leads to very serious consequences. Therefore, if deviations in the size of the spleen are detected, not only a consultation with a hepatologist is necessary, but also a comprehensive examination, necessarily with the use of liver elastometry.

The normal size of the spleen in adults is:

• length – from 8 to 15 centimeters;
• width – from 6 to 9 centimeters;
• thickness – from 4 to 6 centimeters;
• weight – 140-200 grams.

Symptoms

Having increased, this organ can even reach 500 grams, squeezing neighboring organs and causing pain. Since the spleen is located near the stomach, one of the symptoms of its abnormally large size is a feeling of heaviness in the stomach after eating, which appears even if very little is eaten. Sometimes pains are fixed in the abdomen or behind on the left side, this most likely means that some parts of the spleen are destroyed due to insufficient blood supply to them.

Consequences

If we talk about the dangers of an enlarged spleen for the human body as a whole, it is first of all important to note that the processes of hematopoiesis in the body are disturbed. The enlarged organ gets the opportunity to “capture” more than usual, the number of blood cells. It would seem that this is good, the spleen will better cleanse the blood of diseased cells. But, unfortunately, this is not entirely true. Pathological blood cells, when too many of them are extracted, clog the spleen itself, from which it grows even more, but the blood filters worse and worse. As a result, the body begins to destroy not only pathological, but also healthy blood cells, destroy them. Danger threatens red blood cells, platelets and white blood cells.

In the case of a sharp decrease in the number of red blood cells, a person becomes ill with anemia. The destruction of leukocytes destroys the body’s immune system, a person begins to get sick with infectious diseases very often. A lack of platelets leads to a deterioration in blood clotting, which is also very dangerous.

Treatment of the spleen comes down to eliminating the cause of its enlargement, that is, it is necessary to cure the disease that led to failures. In extreme cases, the organ is removed, but this is highly undesirable, since immunity deteriorates significantly, because the blood is left without its filter, and, consequently, the risk of infectious diseases increases.

Important to know!

• What is cirrhosis of the liver?
• Should hepatic steatosis be treated?
• What is fatty liver?
• What is hepatic steatosis?

Tests for diseases of the spleen

What is the spleen and what are its main functions in the body?

The spleen is an unpaired parenchymal organ of the immune system located in the left hypochondrium behind
stomach. From above, the spleen is covered with a connective tissue capsule, the inside is white (due to
accumulations of lymphocytes) and red (venous sinuses) pulp. It plays an important role in the functioning
lymphatic and hematopoietic systems.

The most important and studied functions of this organ are as follows:

1. Immune; The spleen takes part in the formation of cells of the lymphatic system –
   lymphocytes. This process is called lymphopoiesis. In addition, in the lymphoid organ, the formation
   antibodies against foreign antigens.
2. Filtration; The spleen is the “filter” through which blood passes and
   there is a recognition and further destruction of old red blood cells – erythrocytes and white
   platelets. At the same time, hemoglobin, released during this process from erythrocytes, breaks down and
   is transformed into bilirubin and iron-containing transport protein – transferrin. Subsequently, transferrin
   enters the bone marrow and releases iron, which goes to the formation of new red blood cells, and bilirubin –
   bile pigment, which is part of bile, is transferred to the liver.
3. Depository; In addition to the formation and destruction of formed elements, in the spleen,
   deposition of blood. More than 30% of platelets are found in the sinuses of the spleen.
4. Hematopoietic; In addition, in the early stages of human development
   (in utero) in the spleen, the formation of erythrocytes and granulocytic leukocytes (neutrophils,
   eosinophils and basophils), which then begin to be produced in the red bone marrow, while
   the spleen is involved only in the formation of lymphocytes and blood monocytes.

What pathologies of the spleen can occur?

Primary lesions of the spleen include direct trauma, primary tumors (very rare), and
congenital absence of this organ. Most often, the spleen is damaged secondarily, that is, under the influence of
any other existing pathology in the body. Such lesions include:
as a result of thrombosis and / or embolism; may be the result of an infectious process;

What are the clinical signs that suggest spleen disease?

Normally, the spleen is located under the costal arch and is inaccessible to palpation. A healthy person rarely experiences
any sensations and / or pain in the area of ​​​​its projection. This can happen in the case of a strong physical
overvoltage, for example, after running, when there is a large flow of blood into the organ, and the capsule reacts to
stretching. In all other cases, pain is a pathological symptom and may occur due to
compression of the organ, enlargement of the spleen and compression of nearby nerve and vascular branches, etc. Except the pain
An important clinical symptom to watch out for is the size of the spleen. Normal
values ​​fluctuate between 11-13 cm in length and 6-8 cm in diameter, the thickness is no more than 4-5 cm.
An increase in size – splenomegaly – can be observed during infectious processes, tumor neoplasms,
portal hypertension, for which there are a great many reasons, and so on.

Pathologies of the spleen may be accompanied by peripheral edema, as well as effusion into the pleural or abdominal
(ascites) of the cavity, which is most often associated with a primary lesion of the blood outflow system and an increase in pressure in
portal system, for example, in diseases of the liver.

Also, diseases of the spleen are often accompanied by non-specific symptoms, such as weakness, drowsiness,
decreased appetite, decreased attention, etc. In infectious and inflammatory processes, body temperature rises,
with septic lesions, cold clammy sweat may appear.

How to diagnose an organ pathology? What tests are needed to check the spleen?

In the absence of any symptoms from the body, the spleen does not require an unreasonable test. However, in
in case of discomfort in the area of ​​its projection, severe pain, increase in size, appearance
any other symptoms that may indirectly indicate a pathology or be accompanied by changes in
side of this body, you should consult a doctor. The first step is to take a thorough history of
studying all the patient’s complaints, assessing the provoking factors, etc. and physical examination, including percussion,
palpation and auscultation of various organs, if necessary. Then, as prescribed by the doctor for examination
of the spleen and the diagnosis of its pathology, a number of diagnostic procedures are performed, which include both
instrumental and laboratory research methods.

What tests should be done if the spleen hurts?

There is a range of laboratory tests that should be done if a pathology of this disease is suspected.
lymphoid organ, as well as for the diagnosis of other pathologies that could lead to an increase in size and
the appearance of pain. These include:

1. Complete blood count

Complete blood count is extremely important in the diagnosis of spleen pathologies, since functional activity
body is directly related to the production, destruction and deposition of the main blood cells. IN
erythrocytes, platelets, leukocytes of all fractions, hemoglobin, also
evaluate the erythrocyte sedimentation rate (ESR). It is mandatory to study the expanded leukocyte formula
with the determination of the number of both mature cells and blasts. Enlargement of the spleen and, accordingly, characteristic
symptoms in the form of pain and compression of neighboring organs can be observed in malignant blood diseases,
such as myelo- and lymphocytic leukemias. In their diagnosis, the primary role is played by the general analysis with the definition
all types of cells and their ratio. In addition, if an inflammatory process is suspected, which could lead to
are changes in the spleen area, in the general analysis, an increase in leukocytes with a shift to the left (that is,
with an increase in the number of immature forms) and the acceleration of ESR. Also, the analysis allows to suspect hemolytic
anemia, which is characterized by a decrease in the content of red blood cells, hemoglobin and an increase in the number of young
erythrocytes – reticulocytes.

If hemolytic anemia is suspected, a peripheral blood smear on a slide with
subsequent study of the composition and shape of cells under a microscope.

2. Biochemical blood test

the main processes occurring in the body, and the functional activity of a particular organ system. Changes
spleens can be observed, for example, with venous blood stasis due to problems with the liver. for liver disease and
destruction of hepatocytes may indicate increased levels of liver enzymes – AST, ALT, gamma-GT, alkaline
phosphatase in blood plasma, a decrease in the amount of protein. In addition, elevated levels of total and direct bilirubin
can also characterize liver disease.

Hemolytic
anemia, in which untimely (early 120 days after formation) active destruction occurs
blood erythrocytes. There are many reasons for hemolytic anemia. Destruction does not always occur in the spleen,
intravascular hemolysis is also possible, in which the spleen is not involved in the process and remains normal
size to fulfill its function. In this case, any hemolysis is accompanied by an increase in the amount in the blood plasma
total bilirubin due to the fraction of indirect, and in the case of intravascular hemolysis in the blood also increases
hemoglobin level, which is not typical for extravascular (intracellular).

The level of the enzyme lactate dehydrogenase (LDH) is important to assess. Its rise is not specific,
however, in combination with other markers, it may indicate any pathology. The enzyme is represented by 5
isoforms, among which LDH2 can increase in pathologies of the lymph nodes and spleen. Enzyme Growth
observed in tumor processes, including blood diseases, with viral lesions of the spleen and
lymph nodes, pathologies of other organs.

In addition to the above blood parameters, other components are subject to examination:

• glucose, an increase in the concentration of which makes it possible to suspect diabetes mellitus;
• metabolic products excreted by the kidneys – creatinine and urea, characterizing the work of the urinary
  systems;
• uric acid rising in gout;
• electrolytes – sodium, potassium, chlorine;
• and others if necessary.

Blood tests for viral and bacterial infections

Changes in the spleen can cause many infectious diseases. A sharp increase in its size can
occur when infected with the Epstein-Barr virus, belonging to the herpesvirus family (type 4) and causing
Infectious mononucleosis. Cytomegalovirus infection, viral hepatitis B can have an effect on the spleen
and C, in which in the later stages often there is a stagnation of blood in the organ. In addition, changes in the spleen
can be observed with brucellosis, abdominal tuberculosis, parasitic infections, for example, echinococcosis, with
in which the formation of a cyst in the organ is possible, with malaria, etc. The formation of abscesses of the spleen is possible with
serious infectious and inflammatory processes.

PCR is performed to identify the causative agent of the infection that allegedly caused changes in the lymphoid organ
diagnosis and serological testing.

Polymerase chain reaction (PCR) is a high-tech method based on the detection
the genetic material (DNA or RNA) of a pathogen in body fluids. The serological method is based
on the assessment of the number of antibodies (immunoglobulins) of various classes to a particular antigen. Height
class M immunoglobulins indicates an acute process, class G immunoglobulins are produced after 2-4 weeks
after infection and can persist for a long time in the blood.

Immunological study

An immunogram is prescribed by a doctor in cases where there is a suspicion of a decrease in cellular and humoral
immunity: with autoimmune diseases, frequent viral and bacterial infections, as well as with oncological
diseases – lymphocytic leukemia, lymphomas. Assess the total number of lymphocytes, their individual subpopulations,
immunoglobulins of different classes, the level of circulating immune complexes. Changes can be seen with
diseases of the spleen with a decrease in its functional activity. However, the analysis does not indicate the cause
organ damage.

If necessary, the doctor may order other laboratory tests, such as general and biochemical
urine tests, blood tests to evaluate the coagulation system, and others.

Diagnosis of diseases of the spleen by blood tests is almost impossible, but they allow one to suspect
what are the functional and morphological changes of the organ associated with. The most common pathology of the spleen itself
are tumor processes that are diagnosed primarily by instrumental methods – ultrasound, CT and
MRI. An ultrasound examination can reveal a violation of blood flow in the organ and the large vessels that feed it,
changes in the parenchyma, the presence of formations – cysts, nodes, hemangiomas, etc., congenital anomalies can be detected
(for example, an additional lobule), the size of the organ is also estimated.

In case of surgical treatment and removal of the organ, its further histological examination is possible
in order to accurately verify the nature of education.