ABSTRACT
DIFFERENTIAL DIAGNOSIS ■ The differential diagnosis for splenomegaly is listed in Table 1. ■ The causes of splenomegaly
▲ Work hypertrophy from immune response or RBC destruction ▲ Congestive ▲ Myeloproliferative ▲ Infiltrative (nonneoplastic and neoplastic)
Work hypertrophy
Immune response Bacterial infection-TB, subacute bacterial endocarditis Viral infection-cytomegalovirus, Epstein-Barr virus,
HIV, viral hepatitis Fungal infection-histoplasmosis Parasitic infection-toxoplasmosis, malaria Felty syndrome Systemic lupus erythematosus Serum sickness
RBC destruction Hereditary spherocytosis Thalassemia major Pyruvate kinase deficiency Hemolytic diseases
Congestive Cirrhosis & portal hypertension Portal, hepatic, or splenic vein thrombosis Congestive heart failure
Myeloproliferative Chronic myelogenous leukemia Extramedullary hematopoiesis-myeloid metaplasia from myelofibrosis, marrow damage by toxins, radiation, infiltration by tumor or leukemia
Polycythemia vera Lymphoproliferative
Lymphoma Chronic lymphocytic leukemia Acute lymphocytic leukemia Hairy cell leukemia
Infiltrative Nonneoplastic-sarcoidosis, amyloidosis, Gaucher disease Neoplastic-acute nonlymphocytic leukemia, metastatic tumor
Other Trauma Splenic cyst(s) Pyogenic abscess Hemangioma Idiopathic splenomegaly
DIFFERENTIATING THE DIFFERENTIAL History of Present Illness ■ Acute vs. chronic disease
▲ Abrupt onset of symptoms suggests a traumatic, infectious, or inflammatory cause.
