Skip to main content
PMC home page
The Western Journal of Medicine logoLink to The Western Journal of Medicine
. 1998 Aug;169(2):88–97.

Splenomegaly in 2,505 patients at a large university medical center from 1913 to 1995. 1963 to 1995: 449 patients.

R A O'Reilly 1
PMCID: PMC1305177  PMID: 9735689

Abstract

Splenomegaly was studied retrospectively at the University of California, San Francisco (UCSF), School of Medicine in 301 patients from 1963 to 1995 and compared with the UCSF service of the San Francisco General Hospital Medical Center (SFGH) in 148 patients from 1979 to 1994. The combined 449 patients were classified into several diagnostic groups and were studied by means of several clinical and laboratory associations. Hepatic disease in the percentage of patients at UCSF (with those at SFGH given in parentheses) was associated with splenomegaly in 29% (41%), hematologic disease, 32% (16%); infectious diseases, 16% (36%); congestive or inflammatory disease, 10% (4%); primary splenic disease, 6% (1%); other, 5% (1%); and cause unknown, 2% (1%). Massive splenomegaly occurred in 27% of the patients of the combined series, particularly in patients with hematologic diseases. The acquired immunodeficiency syndrome (AIDS) occurred in more than half of the patients with infectious diseases at SFGH and was four times frequent than in the patients at UCSF. The commonest diseases associated with splenomegaly were hematologic (lymphoma), hepatic (chronic liver disease), infectious diseases (AIDS and endocarditis), congestive (congestive heart failure), primary splenic (splenic vein thrombosis), and other (malignancy not metastatic to the spleen). In 11 patients with AIDS and massive splenomegaly, Mycobacterium avium complex occurred in 8 (73%). Splenectomy was performed in 117 patients (26%), primarily for hematologic amelioration. I conclude that for splenomegaly of unknown origin, the invasive procedure of choice for patients with hematologic associations may be a bone marrow biopsy; for hepatic association, a liver biopsy; and for infectious disease associations, a lymph node biopsy, before any consideration of a diagnostic splenectomy.

Full text

PDF

Selected References

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

  1. Adal K. A., Cockerell C. J., Petri W. A., Jr Cat scratch disease, bacillary angiomatosis, and other infections due to Rochalimaea. N Engl J Med. 1994 May 26;330(21):1509–1515. doi: 10.1056/NEJM199405263302108. [DOI] [PubMed] [Google Scholar]
  2. Ando H., Kaneko K., Ito F., Seo T., Watanabe Y., Ito T. Anatomy and etiology of extrahepatic portal vein obstruction in children leading to bleeding esophageal varices. J Am Coll Surg. 1996 Dec;183(6):543–547. [PubMed] [Google Scholar]
  3. Anger B. R., Seifried E., Scheppach J., Heimpel H. Budd-Chiari syndrome and thrombosis of other abdominal vessels in the chronic myeloproliferative diseases. Klin Wochenschr. 1989 Aug 17;67(16):818–825. doi: 10.1007/BF01725198. [DOI] [PubMed] [Google Scholar]
  4. Aquino V. M., Norvell J. M., Buchanan G. R. Acute splenic complications in children with sickle cell-hemoglobin C disease. J Pediatr. 1997 Jun;130(6):961–965. doi: 10.1016/s0022-3476(97)70284-1. [DOI] [PubMed] [Google Scholar]
  5. Arellano L., Segovia M., Otaiza E., Velasco A. Quiste esplénico primario complicado: caso clínico. Rev Med Chil. 1990 Jun;118(6):675–678. [PubMed] [Google Scholar]
  6. 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]
  7. Berjian R. A., Parthasarathy K. L., Didolkar M. S., Bakshi S. P., Moore R. H. Significance of 99mTc-sulfur colloid splenic image in malignant melanoma. J Surg Oncol. 1980;13(1):53–60. doi: 10.1002/jso.2930130109. [DOI] [PubMed] [Google Scholar]
  8. Bunt T. J., Hackler M. T., Greene F. L. Isolated splenic vein thrombosis: the curable variceal hemorrhage. South Med J. 1983 Jul;76(7):936–938. doi: 10.1097/00007611-198307000-00036. [DOI] [PubMed] [Google Scholar]
  9. Case records of the Massachusetts General Hospital. Weekly clinicopathological exercises. Case 48-1985. A 69-year-old man with peripheral vascular disease and hypersplenism. N Engl J Med. 1985 Nov 28;313(22):1405–1412. doi: 10.1056/NEJM198511283132208. [DOI] [PubMed] [Google Scholar]
  10. 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]
  11. Coetzee T. Clinical anatomy and physiology of the spleen. S Afr Med J. 1982 May 15;61(20):737–746. [PubMed] [Google Scholar]
  12. Cohen J., Edelman R. R., Chopra S. Portal vein thrombosis: a review. Am J Med. 1992 Feb;92(2):173–182. doi: 10.1016/0002-9343(92)90109-o. [DOI] [PubMed] [Google Scholar]
  13. Dachman A. H., Ros P. R., Murari P. J., Olmsted W. W., Lichtenstein J. E. Nonparasitic splenic cysts: a report of 52 cases with radiologic-pathologic correlation. AJR Am J Roentgenol. 1986 Sep;147(3):537–542. doi: 10.2214/ajr.147.3.537. [DOI] [PubMed] [Google Scholar]
  14. Danforth D. N., Jr, Fraker D. L. Splenectomy for the massively enlarged spleen. Am Surg. 1991 Feb;57(2):108–113. [PubMed] [Google Scholar]
  15. Dawes L. G., Malangoni M. A. Cystic masses of the spleen. Am Surg. 1986 Jun;52(6):333–336. [PubMed] [Google Scholar]
  16. Eichner E. R., Whitfield C. L. Splenomegaly. An algorithmic approach to diagnosis. JAMA. 1981 Dec 18;246(24):2858–2861. doi: 10.1001/jama.246.24.2858. [DOI] [PubMed] [Google Scholar]
  17. Farid H., O'Connell T. X. Surgical management of massive splenomegaly. Am Surg. 1996 Oct;62(10):803–805. [PubMed] [Google Scholar]
  18. Gaidano G., Carbone A. AIDS-related lymphomas: from pathogenesis to pathology. Br J Haematol. 1995 Jun;90(2):235–243. doi: 10.1111/j.1365-2141.1995.tb05142.x. [DOI] [PubMed] [Google Scholar]
  19. Glynn M. J. Isolated splenic vein thrombosis. Arch Surg. 1986 Jun;121(6):723–725. doi: 10.1001/archsurg.1986.01400060119018. [DOI] [PubMed] [Google Scholar]
  20. Hermann R. E., De Haven K. E., Hawk W. A. Splenectomy for the diagnosis fo splenomegaly. Ann Surg. 1968 Nov;168(5):896–900. doi: 10.1097/00000658-196811000-00017. [DOI] [PMC free article] [PubMed] [Google Scholar]
  21. Horsburgh C. R., Jr Mycobacterium avium complex infection in the acquired immunodeficiency syndrome. N Engl J Med. 1991 May 9;324(19):1332–1338. doi: 10.1056/NEJM199105093241906. [DOI] [PubMed] [Google Scholar]
  22. Hutt M. S., Lowenthal M. N. Chronic splenomegaly in the tropics. Trop Doct. 1974 Apr;4(2):51–55. doi: 10.1177/004947557400400203. [DOI] [PubMed] [Google Scholar]
  23. Ikonopisov R. L., Oreshkov V. I. Possible immunological significance of hepatomegaly and splenomegaly as recorded by hepatic gamma scanning in patients with malignant melanoma. Tumori. 1974 Mar-Apr;60(2):99–104. doi: 10.1177/030089167406000202. [DOI] [PubMed] [Google Scholar]
  24. Jacobs P., Wood L., Dent D. M. Splenectomy in the chronic myeloproliferative syndromes. A retrospective risk-versus-benefit analysis. S Afr Med J. 1992 May 16;81(10):499–503. [PubMed] [Google Scholar]
  25. Johnson P. C., Khardori N., Najjar A. F., Butt F., Mansell P. W., Sarosi G. A. Progressive disseminated histoplasmosis in patients with acquired immunodeficiency syndrome. Am J Med. 1988 Aug;85(2):152–158. doi: 10.1016/s0002-9343(88)80334-6. [DOI] [PubMed] [Google Scholar]
  26. Klingensmith W. C., 3rd Resolution of increased splenic size and uptake of 99mTc-sulfur colloid. J Nucl Med. 1974 Dec;15(12):1203–1204. [PubMed] [Google Scholar]
  27. Kyllerman M., Conradi N., Månsson J. E., Percy A. K., Svennerholm L. Rapidly progressive type III Gaucher disease: deterioration following partial splenectomy. Acta Paediatr Scand. 1990 Apr;79(4):448–453. doi: 10.1111/j.1651-2227.1990.tb11492.x. [DOI] [PubMed] [Google Scholar]
  28. Levin M. Acute hypersplenism and thrombocytopenia: a new presentation of disseminated mycobacterial infection in patients with acquired immunodeficiency syndrome. Acta Haematol. 1994;91(1):28–31. doi: 10.1159/000204240. [DOI] [PubMed] [Google Scholar]
  29. Mattar S. G., Lumsden A. B. The management of splenic artery aneurysms: experience with 23 cases. Am J Surg. 1995 Jun;169(6):580–584. doi: 10.1016/s0002-9610(99)80225-6. [DOI] [PubMed] [Google Scholar]
  30. Mayo W. J. A REVIEW OF 500 SPLENECTOMIES WITH SPECIAL REFERENCE TO MORTALITY AND END RESULTS. Ann Surg. 1928 Sep;88(3):409–415. doi: 10.1097/00000658-192809000-00011. [DOI] [PMC free article] [PubMed] [Google Scholar]
  31. McIntyre O. R., Ebaugh F. G., Jr Palpable spleens in college freshmen. Ann Intern Med. 1967 Feb;66(2):301–306. doi: 10.7326/0003-4819-66-2-301. [DOI] [PubMed] [Google Scholar]
  32. Nguyen C. K., Le T. T., Duong B. T., Dinh P. H., Ta T. H., Tran H. H. Beta-thalassemia/haemoglobin E disease in Vietnam. J Trop Pediatr. 1990 Feb;36(1):43–45. doi: 10.1093/tropej/36.1.43. [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]
  34. O'Reilly R. A. Splenomegaly in 2,505 patients in a large university medical center from 1913 to 1995. 1913 to 1962: 2,056 patients. West J Med. 1998 Aug;169(2):78–87. [PMC free article] [PubMed] [Google Scholar]
  35. OLD L. J., BENACERRAF B., CLARKE D. A., CARSWELL E. A., STOCKERT E. The role of the reticuloendothelial system in the host reaction to neoplasia. Cancer Res. 1961 Oct;21:1281–1300. [PubMed] [Google Scholar]
  36. Pantaleo G., Graziosi C., Demarest J. F., Butini L., Montroni M., Fox C. H., Orenstein J. M., Kotler D. P., Fauci A. S. HIV infection is active and progressive in lymphoid tissue during the clinically latent stage of disease. Nature. 1993 Mar 25;362(6418):355–358. doi: 10.1038/362355a0. [DOI] [PubMed] [Google Scholar]
  37. Press O. W., Press N. O., Kaufman S. D. Evaluation and management of chylous ascites. Ann Intern Med. 1982 Mar;96(3):358–364. doi: 10.7326/0003-4819-96-3-358. [DOI] [PubMed] [Google Scholar]
  38. Rahmouni A., Mathieu D., Golli M., Douek P., Anglade M. C., Caillet H., Vasile N. Value of CT and sonography in the conservative management of acute splenoportal and superior mesenteric venous thrombosis. Gastrointest Radiol. 1992 Spring;17(2):135–140. doi: 10.1007/BF01888529. [DOI] [PubMed] [Google Scholar]
  39. Roberts J. G., Wisbey M., Leach K. G., Baum M. Proceedings: Spleen size in patients with breast cancer. Br J Cancer. 1975 Feb;31(2):262–262. doi: 10.1038/bjc.1975.44. [DOI] [PMC free article] [PubMed] [Google Scholar]
  40. Rockley P. F., Wilcox C. M., Moynihan M., Hewan-Lowe K., Schwartz D. A. Splenic infection simulating lymphoma: an unusual presentation of disseminated Pneumocystis carinii infection. South Med J. 1994 Apr;87(4):530–536. doi: 10.1097/00007611-199404000-00022. [DOI] [PubMed] [Google Scholar]
  41. SCHLOESSER L. L. The diagnostic significance of splenomegaly. Am J Med Sci. 1963 Jan;245:84–90. [PubMed] [Google Scholar]
  42. Sato T., Ozawa T., Kikuchi M., Nakano M., Gejyo F., Hanyu T., Takahashi C., Nakazono K., Murasawa A., Arakawa M. [A case of progressive systemic sclerosis associated with mutilans-type arthropathy and suspected Felty's syndrome]. Ryumachi. 1990 Feb;30(1):53–59. [PubMed] [Google Scholar]
  43. Schwartz S. I. Role of splenectomy in hematologic disorders. World J Surg. 1996 Nov-Dec;20(9):1156–1159. doi: 10.1007/s002689900176. [DOI] [PubMed] [Google Scholar]
  44. Sears D. A., Udden M. M. Splenic infarction, splenic sequestration, and functional hyposplenism in hemoglobin S-C disease. Am J Hematol. 1985 Mar;18(3):261–268. doi: 10.1002/ajh.2830180307. [DOI] [PubMed] [Google Scholar]
  45. Simpson W. G., Schwartz R. W., Strodel W. E. Splenic vein thrombosis. South Med J. 1990 Apr;83(4):417–421. doi: 10.1097/00007611-199004000-00014. [DOI] [PubMed] [Google Scholar]
  46. Singh A. K. A prospective study of the evolution of chronic lymphocytic leukaemia. Leuk Lymphoma. 1992 May;7(1-2):87–97. doi: 10.3109/10428199209053606. [DOI] [PubMed] [Google Scholar]
  47. Solanki D. L., Kletter G. G., Castro O. Acute splenic sequestration crises in adults with sickle cell disease. Am J Med. 1986 May;80(5):985–990. doi: 10.1016/0002-9343(86)90649-2. [DOI] [PubMed] [Google Scholar]
  48. Spelman D. W. Postsplenectomy overwhelming sepsis: reducing the risks. Med J Aust. 1996 Jun 3;164(11):648–648. doi: 10.5694/j.1326-5377.1996.tb122231.x. [DOI] [PubMed] [Google Scholar]
  49. Sutton J. P., Yarborough D. Y., Richards J. T. Isolated splenic vein occlusion. Review of literature and report of an additional case. Arch Surg. 1970 May;100(5):623–626. doi: 10.1001/archsurg.1970.01340230089024. [DOI] [PubMed] [Google Scholar]
  50. Urrutia M., Mergo P. J., Ros L. H., Torres G. M., Ros P. R. Cystic masses of the spleen: radiologic-pathologic correlation. Radiographics. 1996 Jan;16(1):107–129. doi: 10.1148/radiographics.16.1.107. [DOI] [PubMed] [Google Scholar]
  51. Violi F., Ferro D., Basili S., Lionetti R., Rossi E., Merli M., Riggio O., Bezzi M., Capocaccia L. Ongoing prothrombotic state in the portal circulation of cirrhotic patients. Thromb Haemost. 1997 Jan;77(1):44–47. [PubMed] [Google Scholar]
  52. Weintraub L. R. Splenectomy: who, when, and why? Hosp Pract (Off Ed) 1994 Jun 15;29(6):27–34. doi: 10.1080/21548331.1994.11443030. [DOI] [PubMed] [Google Scholar]

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

RESOURCES