Significance of splenomegaly in the differential diagnosis of hematologic disorders

on 9.2.09 with 0 comments

  • Patient may notice splenomegaly as a dragging sensation in the LUQ and may notice early satiety

  • Storage function of spleen may become exaggerated (hypersplenism), leading to anemia, leukopenia, and thrombocytopenia (can be corrected with a splenectomy)

  • Spleen pathology

    • Nonspecific acute splenitis

      • May occur with any blood-borne infection

      • Parenchyma is soft and there is acute congestion (hyperemia) of the red pulp

      • Diffuse increase in neutrophils may lead to abscess formation

      • May have foci of necrosis

    • Congestive splenomegaly

      • Blood isn’t leaving the spleen, leading to capsular and parenchymal fibrosis and hemorrhage

      • Causes

        • Systemic venous congestion from RSHF or cor pulmonal following LSHF (size usually < 500 grams)

        • Cirrhosis and resultant portal HTN (can lead to massive splenomegaly)

        • Thrombosis or compression of the extrahepatic portal vein which may be associated with intrahepatic obstructive disease, vascular inflammation, or neoplasms

    • Splenic infarcts

      • From occlusion of splenic artery or its branches

      • Usually from cardiac emboli; septic infarcts may arise from infective endocarditis of left-sided heart valves

      • Also seen in early stages of sickle cell anemia, with progression to total infarction (autosplenectomy)

    • Splenic neoplasms

      • Primary or secondary involvement by lymphoma or leukemia and metastatic carcinomas are most common

      • Primary neoplasms are rare and include fibromas, osteomas, chondromas, lymphangiomas, and hemangiomas

    • Congenital anomalies (unusual that spleen is the only anomaly)

      • Hypoplasia

      • Asplenia (usually associated with situs inversus and cardiac malformations

      • Accessory spleens (spleniculi)

        • Common; come from splenic trauma seeding peritoneum with lymphoid tissue

        • Only significant if all splenic tissue needs to be removed for therapeutic reasons, such as in hereditary spherocytosis, refractory thrombocytopenic purpura, and some causes of hypersplenism

    • Rupture

      • May be traumatic or spontaneous; usually necessitates splenectomy from massive intraperitoneal hemorrhage

      • Spontaneous rupture associated with mono, malaria, typhoid F, leukemia, and acute splenitis

Category: Medical Subject Notes , Pathology Notes



Post a Comment