Massive Splenomegaly

Massive Splenomegaly

Question. Write short note on diffrential diagnosis of massive splenomegaly.

Answer. When there is enlargement of spleen with its weight greater than 1000 g, it is known as splenomegaly.

massive splenomegaly Differential Diagnosis

Cirrhosis of liver:

• Symptoms and signs ofhepatocellular failure: Spider nevi,liver palms, alopecia, gynecomastia and testicular atrophy in males, icterus, Foetor hepaticus. Palpable enlarged liver.
• Evidence ofportal hypertension: Ascites, prominent veins on abdomen, hematemesis, piles.
• Diagnosis by liver biopsy demonstration of oesophageal varices by barium swallow, laparoscopy and scanning.

Massive Splenomegaly: Causes, Symptoms, and Diagnosis

Infections, subacute and chronic:

Chronic malaria:

• History of fever with rigors with classical features of the attack, like cold stage, hot stage, sweating stage.
• The spleen is very large and firm.
• The liver may be enlarged.
• Severe anemia.
• Malarial parasites in peripheral blood or sternal marrow.
• Leucopenia.
• Therapeutic test with an adequate dose of antimalarial drug during fever.

Kala­azar:

• Residence in endemic area.
• Splenomegaly: which may be massive.
• Recurrent fever: Double rise of temperature in 24
  hours may be seen.
• Liver enlarged but not grossly like spleen.
  Anaemia.
• Loss of hair and pigmentation of skin.
• Generalized lymphadenopathy especially in children. Nodes are soft, non­tender.
• Other features are cough, hemorrhagic features
• LD bodies—on stained material from bone marrow or splenic aspirate.

Symptoms of Massive Splenomegaly and its Clinical Implications

Sub-acute infective endocarditis:

• Unexplained fever.
• Presence of cardiac murmur.
• Presence of petechiae, anemia, peripheral emboli,
  clubbing of figers.
• Red cells in urine.
• Positive blood culture.

Brucellosis:

• History of ingestion of raw milk, or occupation hazard in veterinary surgeons, laboratory personnel or slaughter house workers.
• Patient not toxic inspite of high fever.
• Spleen of moderate size, rarely massive.
• Liver may be enlarged, particularly, if spleen is very large.
• Back pain common.
• Culture of organism from blood or bone marrow.
• Complement fiation and anti-human globulin tests in chronic infection.

Causes of Massive Splenomegaly

Tuberculous splenomegaly: In rare cases, tuberculous enlargement ofspleen occurs with litte involvement of other organs.

Blood picture shows anemia, leucopenia or thrombocytopenia either single or in combination.

Weakness, lassitude, loss of weight and often pyrexia.

Bleeding may occur. X­ray of spleen may demonstrate areas of calcifiation.