Enlarged spleen

Overview

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