Presentation
Chronic splenic enlargement with now clinical features of cirrhosis.
Patient Data
Enlarged spleen spans 18 cm. Dilated tortuous splenic vein with average 18 mm caliber. Dilated splenic artery. Dilated portal vein 14 mm. Liver shows nodular surface and parenchyma with mild widening of interlobar fissure. Mild fluid in pelvis. No focal liver lesions. No splenic infarctions. No portosystemic collaterals.
The left kidney is displaced inferomedially by the enlarged spleen. Multiple bilateral renal calyceal stones.
Case Discussion
This case is typical of massive splenomegaly resulting in left-sided portal hypertension and secondary liver cirrhosis. The patient was referred for imaging to rule out splenic vein thrombosis and sinistral portal hypertension, however no pancreatic mass lesions nor any large gastric varices were identified.