Skip to main content
NCBI home page
The Western Journal of Medicine logoLink to The Western Journal of Medicine
. 1998 Aug;169(2):78–87.

Splenomegaly in 2,505 patients in a large university medical center from 1913 to 1995. 1913 to 1962: 2,056 patients.

R A O'Reilly 1
PMCID: PMC1305176  PMID: 9735688

Abstract

Splenomegaly was studied retrospectively at the University of California, San Francisco, School of Medicine, on all patients (N = 2,056) for the years 1913 to 1962. The patients were classified into several diagnostic groups, and these groups were tested for statistical significance (chi(2)) with many clinical and laboratory variables to determine their predictive value. Hematologic disorders were associated with 57% of cases of splenomegaly and 81% of cases of massive splenomegaly. Among patients with splenomegaly, 19% had infectious diseases, 11% had hepatic diseases, and 9% had congestive or inflammatory disorders. The residual 4% were considered to have primary splenic disorders or a disorder of unknown cause. The commonest diseases associated with splenomegaly were hematologic (acute and chronic leukemias), infectious (malaria, endocarditis, and tuberculosis), hepatic (chronic liver disease), congestive (congestive heart failure), inflammatory (thyrotoxicosis), and other (cancers not metastatic to the spleen). The diseases most frequently associated with massive splenomegaly were the chronic leukemias. The disease with the highest incidence of massive splenomegaly was myelofibrosis (23 of 29 patients, 78%). Splenectomy was performed in 154 patients (7%), primarily for hematologic amelioration and hepatic hypersplenism. Hematologic diseases showed significant associations with lymphadenopathy, generalized lymphadenopathy, massive splenomegaly, and cytoses (P .001) and with progressive splenic enlargement (P < .02). Infectious diseases showed significant association with fever, and hepatic diseases showed significant association with abnormal results of liver function tests (P < .001). The findings of this retrospective study should be validated prospectively.

Full text

PDF
78

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. AUBERT A., LERCHE C. Subacute bacterial endocarditis in a child, 10 months old, successfully treated with streptomycin. Am Heart J. 1950 Jan;39(1):141–143. doi: 10.1016/0002-8703(50)90019-6. [DOI] [PubMed] [Google Scholar]
  2. Allhiser J. N., McKnight T. A., Shank J. C. Lymphadenopathy in a family practice. J Fam Pract. 1981 Jan;12(1):27–32. [PubMed] [Google Scholar]
  3. Applebaum G. D., Mathisen G. Spinal brucellosis in a southern California resident. West J Med. 1997 Jan;166(1):61–65. [PMC free article] [PubMed] [Google Scholar]
  4. Archambeaud-Mouveroux F., Morand P., Bernard P., Sautereau D., Meloni B., Antoine E., Catanzano G. Atteinte hépatique au cours de la syphilis secondaire. Gastroenterol Clin Biol. 1987 Jan;11(1):93–95. [PubMed] [Google Scholar]
  5. BJORKMAN S. E. On the occurrence of a vascular murmur over greatly enlarged spleens. Acta Med Scand. 1953;145(2):79–83. [PubMed] [Google Scholar]
  6. BLOCK M., JACOBSON L. O. Myeloid metaplasia. J Am Med Assoc. 1950 Aug 19;143(16):1390–1396. doi: 10.1001/jama.1950.02910510008002. [DOI] [PubMed] [Google Scholar]
  7. Breslow L. Public health report. Calif Med. 1967 Jun;106(6):496–497. [PMC free article] [PubMed] [Google Scholar]
  8. Cavanna L., Civardi G., Fornari F., Di Stasi M., Sbolli G., Buscarini E., Vallisa D., Rossi S., Tansini P., Buscarini L. Ultrasonically guided percutaneous splenic tissue core biopsy in patients with malignant lymphomas. Cancer. 1992 Jun 15;69(12):2932–2936. doi: 10.1002/1097-0142(19920615)69:12<2932::aid-cncr2820691211>3.0.co;2-7. [DOI] [PubMed] [Google Scholar]
  9. Clain D., Wartnaby K., Sherlock S. Abdominal arterial murmurs in liver disease. Lancet. 1966 Sep 3;2(7462):516–519. doi: 10.1016/s0140-6736(66)92878-9. [DOI] [PubMed] [Google Scholar]
  10. Crosby E., Llosa L., Miro Quesada M., Carrillo C., Gotuzzo E. Hematologic changes in brucellosis. J Infect Dis. 1984 Sep;150(3):419–424. doi: 10.1093/infdis/150.3.419. [DOI] [PubMed] [Google Scholar]
  11. DAVIDSON S. Clinical picture of pernicious anaemia prior to introduction of liver therapy in 1926 and in Edinburgh subsequent to 1944. Br Med J. 1957 Feb 2;1(5013):241–243. doi: 10.1136/bmj.1.5013.241. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. De Cock K. M., Hodgen A. N., Lucas S. B., Jupp R. A., Slavin B., Arap Siongok T. K., Rees P. H. Chronic splenomegaly in Nairobi, Kenya. I. Epidemiology, malarial antibody and immunoglobulin levels. Trans R Soc Trop Med Hyg. 1987;81(1):100–106. doi: 10.1016/0035-9203(87)90296-3. [DOI] [PubMed] [Google Scholar]
  13. Dressler F. A., Roberts W. C. Infective endocarditis in opiate addicts: analysis of 80 cases studied at necropsy. Am J Cardiol. 1989 May 15;63(17):1240–1257. doi: 10.1016/0002-9149(89)90186-0. [DOI] [PubMed] [Google Scholar]
  14. Eastman C. J. Graves' disease 150 years on. Med J Aust. 1996 Nov 4;165(9):467–468. doi: 10.5694/j.1326-5377.1996.tb138608.x. [DOI] [PubMed] [Google Scholar]
  15. Essop A. R., Posen J. A., Hodkinson J. H., Segal I. Tuberculosis hepatitis: a clinical review of 96 cases. Q J Med. 1984 Autumn;53(212):465–477. [PubMed] [Google Scholar]
  16. FENSTER L. F., KLATSKIN G. Manifestations of metastatic tumors of the liver. A study of eighty-one patients subjected to needle biopsy. Am J Med. 1961 Aug;31:238–248. doi: 10.1016/0002-9343(61)90112-7. [DOI] [PubMed] [Google Scholar]
  17. Fehér J., Somogyi T., Timmer M., Józsa L. Early syphilitic hepatitis. Lancet. 1975 Nov 8;2(7941):896–899. doi: 10.1016/s0140-6736(75)92129-7. [DOI] [PubMed] [Google Scholar]
  18. Firkin B. G. As time goes by: reflections on 40 years of academic medicine and biomedical research. Med J Aust. 1995 Dec 4;163(11-12):604–606. doi: 10.5694/j.1326-5377.1995.tb124766.x. [DOI] [PubMed] [Google Scholar]
  19. Freund R., Pichl J., Heyder N., Rödl W., Riemann J. F. Splenic abscess-clinical symptoms and diagnostic possibilities. Am J Gastroenterol. 1982 Jan;77(1):35–38. [PubMed] [Google Scholar]
  20. Grammont-Cupillard M., Berthet-Badetti L., Dellamonica P. Brucellosis from sniffing bacteriological cultures. Lancet. 1996 Dec 21;348(9043):1733–1734. doi: 10.1016/S0140-6736(05)65855-2. [DOI] [PubMed] [Google Scholar]
  21. Held J. L., Kohn S. R. Vitiligo and pernicious anemia presenting as congestive heart failure. Cutis. 1990 Sep;46(3):268–270. [PubMed] [Google Scholar]
  22. Hussey G., Chisholm T., Kibel M. Miliary tuberculosis in children: a review of 94 cases. Pediatr Infect Dis J. 1991 Nov;10(11):832–836. doi: 10.1097/00006454-199111000-00008. [DOI] [PubMed] [Google Scholar]
  23. Hustinx W. N., Nio Y., Speelman P. Buiktyfus en paratyfus in twee academische ziekenhuizen: 1984-1990. Ned Tijdschr Geneeskd. 1993 Feb 6;137(6):291–294. [PubMed] [Google Scholar]
  24. Jain S. R., Kathpal G. S., Sepaha G. C., Raman R. Splenic bruit. J Assoc Physicians India. 1969 Sep;17(9):537–541. [PubMed] [Google Scholar]
  25. Jaroch M. T., Broughan T. A., Hermann R. E. The natural history of splenic infarction. Surgery. 1986 Oct;100(4):743–750. [PubMed] [Google Scholar]
  26. Klotz S. A., Jorgensen J. H., Buckwold F. J., Craven P. C. Typhoid fever. An epidemic with remarkably few clinical signs and symptoms. Arch Intern Med. 1984 Mar;144(3):533–537. doi: 10.1001/archinte.144.3.533. [DOI] [PubMed] [Google Scholar]
  27. Koh M. T., Lim C. T. Early congenital syphilis: experience with 13 consecutive cases seen at the University Hospital, Kuala Lumpur. Singapore Med J. 1991 Aug;32(4):230–232. [PubMed] [Google Scholar]
  28. LINDEBOOM G. A. WRIJFGERUISEN IN DE BUIK. Ned Tijdschr Geneeskd. 1964 Oct 31;108:2113–2117. [PubMed] [Google Scholar]
  29. Letoquart J. P., La Gamma A., Kunin N., Grosbois B., Mambrini A., Leblay R. Splenectomy for splenomegaly exceeding 1000 grams: analysis of 47 patients. Br J Surg. 1993 Mar;80(3):334–335. doi: 10.1002/bjs.1800800322. [DOI] [PubMed] [Google Scholar]
  30. Libman H. Generalized lymphadenopathy. J Gen Intern Med. 1987 Jan-Feb;2(1):48–58. doi: 10.1007/BF02596251. [DOI] [PubMed] [Google Scholar]
  31. Lishner M., Lang R., Hamlet Y., Halph E., Steiner Z., Radnay J., Ravid M. Fine needle aspiration biopsy in patients with diffusely enlarged spleens. Acta Cytol. 1996 Mar-Apr;40(2):196–198. doi: 10.1159/000333737. [DOI] [PubMed] [Google Scholar]
  32. Marynick S. P. Splenomegaly in thyrotoxicosis. JAMA. 1982 May 28;247(20):2782–2782. doi: 10.1001/jama.1982.03320450020022. [DOI] [PubMed] [Google Scholar]
  33. O'Reilly R. A. Splenomegaly at a United States County Hospital: diagnostic evaluation of 170 patients. Am J Med Sci. 1996 Oct;312(4):160–165. doi: 10.1097/00000441-199610000-00003. [DOI] [PubMed] [Google Scholar]
  35. Pruthi R. K., Tefferi A., Petitt R. M. Reversible marked splenomegaly in pernicious anemia. Ann Intern Med. 1993 Nov 15;119(10):1053–1053. doi: 10.7326/0003-4819-119-10-199311150-00025. [DOI] [PubMed] [Google Scholar]
  36. Pérez C. M., León A., Oddó D., Sirham M., Vinés E. F., Labarca J. A., Acuña G. G. Isolated gummatous splenitis. Clin Infect Dis. 1995 Jul;21(1):228–229. doi: 10.1093/clinids/21.1.228. [DOI] [PubMed] [Google Scholar]
  37. Rosenstein E. D., Kramer N. Felty's and pseudo-Felty's syndromes. Semin Arthritis Rheum. 1991 Dec;21(3):129–142. doi: 10.1016/0049-0172(91)90002-h. [DOI] [PubMed] [Google Scholar]
  38. SCHLOESSER L. L. The diagnostic significance of splenomegaly. Am J Med Sci. 1963 Jan;245:84–90. [PubMed] [Google Scholar]
  39. Savage D., Brown J. Endocarditis due to group A streptococcus. Am J Med Sci. 1981 Nov-Dec;282(3):98–103. doi: 10.1097/00000441-198111000-00001. [DOI] [PubMed] [Google Scholar]
  40. Schneider P. J., Nernoff J., 3rd, Gold J. A. Acute Salmonella endocarditis. Report of a case and review. Arch Intern Med. 1967 Oct;120(4):478–486. doi: 10.1001/archinte.120.4.478. [DOI] [PubMed] [Google Scholar]
  41. Svenson J. E., MacLean J. D., Gyorkos T. W., Keystone J. Imported malaria. Clinical presentation and examination of symptomatic travelers. Arch Intern Med. 1995 Apr 24;155(8):861–868. doi: 10.1001/archinte.155.8.861. [DOI] [PubMed] [Google Scholar]
  42. Yew F. S., Chew S. K., Goh K. T., Monteiro E. H., Lim Y. S. Typhoid fever in Singapore: a review of 370 cases. J Trop Med Hyg. 1991 Oct;94(5):352–357. [PubMed] [Google Scholar]
  43. Zenilman J. M. Typhoid fever. JAMA. 1997 Sep 10;278(10):847–850. [PubMed] [Google Scholar]
  44. Zucker J. R. Changing patterns of autochthonous malaria transmission in the United States: a review of recent outbreaks. Emerg Infect Dis. 1996 Jan-Mar;2(1):37–43. doi: 10.3201/eid0201.960104. [DOI] [PMC free article] [PubMed] [Google Scholar]
  45. van de Poll N. E., van Dis H., Bermond B. The induction of mounting behavior in female rats by p-chlorophenylalanine. Eur J Pharmacol. 1977 Jan 21;41(2):225–229. doi: 10.1016/0014-2999(77)90214-x. [DOI] [PubMed] [Google Scholar]

Articles from Western Journal of Medicine are provided here courtesy of BMJ Publishing Group

RESOURCES