Splenomegaly is a term which refers to enlargement of the spleen. The normal adult splenic length upper limit is usually around 12-15 cm. It can also be helpful to know how to calculate splenic index, volume and mass by CT and MR techniques. Massive splenomegaly is a term used when the spleen weighs >1000 g 5.
The causes of splenomegaly are protean, and can be thought of under a number of headings:
- haematologic disease
- storage diseases/metabolic/infiltrative disorders
- neoplastic (non-haematologic)
- connective tissue disorders
- neoplastic/proliferative/redistribution of hematopoiesis
- cirrhosis: portal hypertension (common)
- congestive splenomegaly (Banti syndrome)
- splenic vein obstruction
- portal vein obstruction
- right heart failure
- parasitic disease
Storage diseases/metabolic/infiltrative disorders
- Gaucher disease
- glycogen storage disease
- Niemann-Pick disease
- lymphoma: commonest neoplastic etiology
- metastases (breast, lung, colon, ovary, melanoma)
Connective tissue disorders
- rheumatoid arthritis
- systemic lupus erythematosus (SLE)
* may cause massive splenomegaly 3
The shape and orientation of a spleen makes accurate linear measurement difficult.
On CT, a splenic width measurement (largest anterior-posterior measurement on axial images) of greater than 10.5 cm is the most accurate single measurement for mild to moderate splenomegaly in patients with cirrhosis; while a craniocaudal measurement of greater than 14.6 cm is the most accurate single measurement for massive splenomegaly 4.
On sonographic assessment, a length of 12 cm is generally considered the upper limit of normal.
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- 4. Nuffer Z, Marini T, Rupasov A, Kwak S, Bhatt S. The Best Single Measurement for Assessing Splenomegaly in Patients with Cirrhotic Liver Morphology. Academic Radiology. 2017. Academic Radiology (abstract)
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