Splenomegaly – Diagnostic validity, work-up, and underlying causes

Rotbain, Emelie Curovic; Hansen, Dennis Lund; Muckadell, O. Schaffalitzky de; Wibrand, Flemming; Lund, Allan Meldgaard; Frederiksen, Henrik

doi:10.1371/journal.pone.0186674

Cited by 30 publications

(24 citation statements)

References 24 publications

(27 reference statements)

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“…A single measurement of splenic length provides a clinically useful indication of true splenic size (length, volume and weight) (Loftus et al 1999); splenic width provides similar or greater degrees of accuracy (Lamb et al 2002). Size determination may be highly clinically relevant, and the causes of abnormal splenic size are multifarious (Curovic Rotbain et al 2017).…”

Section: Atypical Location Size and Shape Variationsmentioning

confidence: 99%

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WFUMB Position Paper—Incidental Findings, How to Manage: Spleen

Trenker

Görg

Freeman

et al. 2021

Ultrasound in Medicine & Biology

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The World Federation for Ultrasound in Medicine and Biology (WFUMB) is addressing the issue of incidental findings (IFs) with a series of publications entitled "Incidental Imaging Findings-The Role of Medical Ultrasound." IFs are less commonly encountered in the spleen than in many other abdominal organs but remain a frequent dilemma in clinical practice. A histological diagnosis is rarely necessary for patient management. Many IFs, such as secondary spleens and splenic cysts, are harmless and do not require any further investigation. The diagnosis of many other focal splenic lesions is, however, often problematic. The following overview is intended to illustrate a variety of incidentally detected spleen pathologies such as size variants, shape variants, secondary spleens, focal splenic lesions and splenic calcifications. It should aid the examiner in establishing the diagnosis. Moreover, it should help the ultrasound practitioner decide which pathologies need no further investigation, those requiring interval imaging and cases in which immediate further diagnostic procedures are required.In patients with splenomegaly (>13 £ 6 cm), an imaging, clinical and laboratory evaluation is usually required to determine the underlying cause.Most congenital variants of the spleen, and accessory spleens, have characteristic ultrasound appearances and do not require further evaluation or follow-up.The use of ultrasound contrast microbubbles (contrast-enhanced ultrasound) is of particular value in ultrasound imaging of the spleen when an indeterminate incidental finding is encountered.Splenosis can be confidently diagnosed with contrast-enhanced ultrasound and usually requires no additional imaging or follow-up.The cause of an inhomogeneous splenic parenchyma must be clarified, especially to exclude sarcoidosis or lymphomatous infiltration. Incidental indeterminate focal splenic lesions (with the exception of simple cysts) are often best managed by an interval follow-up examination (initially after 3 months) unless there clearly malignant clinical or sonographic features.For splenic calcifications, including the "starry sky" spleen, no follow-up is necessary.

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Section: Atypical Location Size and Shape Variationsmentioning

confidence: 99%

“…Shear-wave elastography has been found to be useful in predicting the etiology of splenomegaly (Batur et al 2019;Yalcin and Demir 2021). However, in a significant number of cases, the root cause cannot be identified, even after a complete diagnostic workup (Curovic Rotbain et al 2017).…”

Section: Splenomegalymentioning

confidence: 99%

WFUMB Position Paper—Incidental Findings, How to Manage: Spleen

Trenker

Görg

Freeman

et al. 2021

Ultrasound in Medicine & Biology

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“…Splenomegaly was diagnosed by the longest diameter on axial CT or MRI, whose value of 10 cm was used as the upper limit of normality for the splenic length. 15,16 The following blood vessels were focused on as portosystemic collaterals, and evaluated for formation and development on dynamic CT or MRI: paraesophageal vein, left gastric vein, posterior gastric vein, short gastric vein, paraumbilical vein, and splenorenal shunt. 17,18 Endoscopic examination findings were not analyzed in this study.…”

Section: Definition Of Signs Of Advanced Portal Hypertensionmentioning

confidence: 99%

Therapeutic efficacy of lenvatinib in hepatocellular carcinoma patients with portal hypertension

Maesaka

Sakamori

Yamada

et al. 2020

Hepatology Research

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Aim Preserved liver function may be an important factor affecting therapeutic efficacy in hepatocellular carcinoma patients treated with lenvatinib, but not all patients can be treated while preserving liver function. This study evaluated the therapeutic efficacy of lenvatinib in patients with poor liver function with and without portal hypertension. Methods This prospectively registered multicenter study analyzed 93 patients treated with lenvatinib. Progression‐free survival was compared between patients with and without advanced portal hypertension according to baseline liver function. Advanced portal hypertension was defined as having both splenomegaly and any portosystemic collaterals. Results A total of 37 patients (40.7%) had advanced portal hypertension. Progression‐free survival did not differ between patients with and without advanced portal hypertension in the entire cohort (median 7.6 vs. 4.1 months, respectively; P = 0.148), but was significantly longer in patients with advanced portal hypertension than in those without advanced portal hypertension in the albumin‐bilirubin grade 2 or 3 group (median 7.6 vs. 2.1 months, respectively; P = 0.016). In a multivariate analysis, the presence of advanced portal hypertension was identified as the only significant predictor associated with prolonged progression‐free survival in the albumin‐bilirubin grade 2 or 3 group. Conclusions Advanced portal hypertension was associated with the therapeutic efficacy of lenvatinib in controlling the progression of hepatocellular carcinoma in patients with poor liver function.

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“…Splenomegaly is an increase in spleen size that may be caused by a number of conditions, including haematological disorders, liver diseases, infectious diseases, inflammatory diseases and primary splenic diseases (1). Regarding haematological disorders, the most common causes of splenomegaly include lymphoma, myeloproliferative neoplasms, chronic lymphocytic leukaemia and hairy cell leukaemia (2).…”

Section: Introductionmentioning

confidence: 99%

Radiotherapy for symptom palliation of splenomegaly in patients with haematological malignancies

et al. 2021

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Splenomegaly severely compromises the quality of life of those affected. The aim of the present study was to describe the clinical characteristics of patients with haematological disorders who receive radiotherapy for splenomegaly, particularly focusing on the changes in spleen volume. The present study conducted a retrospective analysis of consecutive patients with haematological disorders who underwent splenic radiotherapy with palliative intent at the Department of Radiology of the University of Tokyo Hospital between June 2008 and June 2019. Pre-and post-radiotherapy spleen volumes were measured from computed tomography images. A total of 8 patients (5 men and 3 women) with a median age of 59 years (range, 46-76 years) were included. The median total prescription and fractional doses were 4.5 Gy (range, 1.5-10 Gy) and 0.78 Gy (range, 0.5-2.0 Gy), respectively. A total of 5 patients (62.5%) experienced a reduction in spleen volume. The mean ± SD spleen sizes pre-and post-radiotherapy were 1,887±1,011 and 1,368±577 ml, respectively. The mean variation rate in spleen volume was -19.1±24.7%, and the case with the most notable improvement in the present study exhibited a -52.4% change. Of the 5 patients who experienced pain prior to radiotherapy, 3 achieved pain relief, 1 did not experience any change and 1 patient was not assessed post-radiotherapy. Therefore, the findings of the present study revealed that palliative radiotherapy for splenomegaly may achieve symptom palliation and radiological volumetric effects in patients with haematological disorders.

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Splenomegaly – Diagnostic validity, work-up, and underlying causes

Cited by 30 publications

References 24 publications

WFUMB Position Paper—Incidental Findings, How to Manage: Spleen

WFUMB Position Paper—Incidental Findings, How to Manage: Spleen

Therapeutic efficacy of lenvatinib in hepatocellular carcinoma patients with portal hypertension

Radiotherapy for symptom palliation of splenomegaly in patients with haematological malignancies

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