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:
- haematological disease
- storage diseases/metabolic/infiltrative disorders
- neoplastic (non-haematologic)
- connective tissue disorders
- neoplastic/proliferative/redistribution of haematopoesis
- 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: (common)
- 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 cranial-caudal height 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.
- 1. Weissleder R, Wittenberg J, Harisinghani MG et-al. Primer of diagnostic imaging. Mosby Inc. (2007) ISBN:0323040683. Read it at Google Books - Find it at Amazon
- 2. Reeder MM, Felson B. Reeder and Felson's gamuts in radiology, comprehensive lists of roentgen differential diagnosis. Springer Verlag. (2003) ISBN:0387955887. Read it at Google Books - Find it at Amazon
- 3. Taylor AJ, Dodds WJ, Erickson SJ et-al. CT of acquired abnormalities of the spleen. AJR Am J Roentgenol. 1991;157 (6): 1213-9. AJR Am J Roentgenol (abstract) - Pubmed citation
- 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)
- 5. Prassopoulos P, Daskalogiannaki M, Raissaki M, Hatjidakis A, Gourtsoyiannis N. Determination of normal splenic volume on computed tomography in relation to age, gender and body habitus. European radiology. 7 (2): 246-8. doi:10.1007/s003300050145 - Pubmed