Splenomegaly
What is splenomegaly?

Splenomegaly means enlargement of the spleen. The spleen is an organ rich in blood vessels, located in the upper left part of the abdomen, beneath the ribs and near the stomach. It removes old or damaged cells from the blood and helps protect the body against infections. Normally, it cannot usually be felt because it lies beneath the ribs.

The spleen may enlarge because it holds more blood, works harder, or accumulates cells or other substances. The degree of enlargement varies. Sometimes it is only slightly enlarged and is found incidentally; in other cases, it becomes noticeably larger and can be felt during an examination.

What is hypersplenism?

In some people, an enlarged spleen may retain and destroy more blood cells than usual. This is called hypersplenism and can lead to low red blood cell, white blood cell, and/or platelet counts.

What are the symptoms of splenomegaly?

Splenomegaly often causes no symptoms. When symptoms occur, they may be related to the size of the spleen, pressure on nearby organs, or the condition causing the enlargement. Typical signs include:

Feeling full quickly, even after a small meal.
Bloating or discomfort in the upper left abdomen.
Pain that may spread to the left shoulder.
Fatigue or recurring infections.

What causes splenomegaly?

There are many possible causes. A doctor considers them in light of the symptoms, examination, and test results. Common hematologic mechanisms include:

Hemolysis (rapid destruction of red blood cells). When red blood cells are destroyed faster than usual, the spleen works harder to remove them and may enlarge.
Extramedullary hematopoiesis (production of blood cells outside the bone marrow). When blood cell production in the bone marrow is insufficient or disrupted, the spleen may take part in this process and enlarge.
Infiltration by abnormal cells. In some leukemias, lymphomas, and myeloproliferative neoplasms, abnormal cells accumulate in the spleen and cause it to enlarge.

Other causes include:

Portal hypertension, usually resulting from chronic liver disease such as cirrhosis.
Infections, including infectious mononucleosis and other bacterial, viral, or parasitic infections.
Autoimmune or inflammatory diseases, such as systemic lupus erythematosus or Felty syndrome.
Inherited storage disorders, such as Gaucher disease and, less commonly, Niemann–Pick disease.

When should you see a doctor?

Seek a medical evaluation if you have persistent discomfort in the upper left abdomen, feel full quickly, experience fatigue, or have recurring infections.

⚠️ Seek urgent medical attention if you have:

Sudden, severe pain in the upper left abdomen or left shoulder, especially after a blow or fall.
Dizziness, marked weakness, or fainting.

How is splenomegaly diagnosed?

The first step is a medical visit. The doctor asks about your symptoms and examines your abdomen to assess the spleen’s size and tenderness. Depending on the findings, tests may include:

Blood tests to assess blood cells and look for signs of infection or another cause.
Abdominal ultrasound, a radiation-free way to measure the spleen.
Other imaging tests in selected cases to assess the spleen and nearby organs more closely.

The aim is to identify the cause of the enlargement, not simply measure the spleen.

How is splenomegaly treated?

Treatment depends on the underlying cause. In many cases, treating that condition reduces the size of the spleen and improves symptoms. With some chronic conditions, the spleen may remain enlarged even when the disease is under control.

Surgical removal of the spleen (splenectomy) is recommended only in selected cases when the benefits outweigh the risks, for example, in certain blood disorders or severe hypersplenism.

Can splenomegaly be prevented?

Splenomegaly often cannot be prevented directly because it results from another condition. However, you can reduce the risk of complications:

Follow the recommended treatment and checkups for the underlying condition.
Avoid contact sports, lifting heavy weights, and activities that could involve a blow to the abdomen until your doctor considers them safe.
Always wear a seat belt in a vehicle.
Seek urgent evaluation after a blow or fall if you develop pain in the upper left abdomen.

Why does timely evaluation matter?

An enlarged spleen does not necessarily indicate a serious disease. The cause may be temporary, such as a viral infection, but it may also be a condition that requires specific evaluation and treatment. Timely assessment helps identify and treat the cause.

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📌 Reviewed by Dr. Irma Lapaj, Hematologist, Klinika Kajo.

Splenomegaly