Diseases & Conditions

Enlarged spleen

Your spleen is a small organ located just below your rib cage on your left side. Normally, your spleen is about the size of a fist, but a number of conditions — from infections to liver disease and some cancers — can cause an enlarged spleen (splenomegaly).

Most people don't have symptoms with an enlarged spleen, and the problem is often discovered during a routine physical exam. If you're found to have an enlarged spleen, you're likely to have imaging and blood tests to help determine the cause.

Treatment for an enlarged spleen focuses on relieving the underlying condition. Although surgically removing an enlarged spleen isn't a first choice, it may be an option for you in certain situations.

An enlarged spleen often causes no symptoms. Some people, however, may experience one or more of the following symptoms of enlarged spleen:

• Pain in the left upper abdomen that may spread to the left shoulder
• Feeling full without eating or after eating only a small amount — this can occur when an enlarged spleen presses on your stomach
• Anemia
• Fatigue
• Frequent infections
• Easy bleeding

See your doctor promptly if you have pain in your left upper abdomen, especially if it's severe or the pain gets worse when you take a deep breath.

An enlarged spleen is usually detected during a physical exam. Your doctor can often feel the enlargement by gently examining your left upper abdomen, just under your rib cage. Keep in mind that some people, especially those who are slender, may have healthy, normal-sized spleens that can be felt during an exam.

The diagnosis is usually confirmed with blood tests and an imaging study of your abdomen, such as an ultrasound or computerized tomography (CT) scan. These tests can help determine the size of your spleen and whether it's crowding other organs. Magnetic resonance imagining (MRI) may be used to trace blood flow through the spleen.

In general, you don't need any special preparation for an ultrasound or MRI. If you're having a CT scan, however, you may need to refrain from eating before the test. If you need to prepare, your doctor will let you know well in advance.

Finding the cause
Sometimes you may need further testing to identify what's causing an enlarged spleen, including liver function tests and a bone marrow exam, which can give more detailed information about your blood cells than can blood drawn from a vein.

In some cases, a sample of solid bone marrow is removed in a procedure called a bone marrow biopsy. Or, you may have a bone marrow aspiration, which removes the liquid portion of your marrow. In many cases, both procedures are performed at the same time (bone marrow exam).

Both the liquid and solid bone marrow samples are frequently taken from the same place on the back of one of your hipbones. A needle is inserted into the bone through an incision. Because bone marrow tests are painful, you'll receive either general or local anesthesia before the test.

Because an enlarged spleen can reduce the number of healthy red blood cells, platelets and white cells in your bloodstream, you may develop anemia, increased bleeding or frequent infections. More serious is the risk of a ruptured spleen. Even healthy spleens are soft and easily damaged, especially in car crashes. When your spleen is enlarged, the possibility of rupture is far greater. A ruptured spleen can cause life-threatening bleeding into your abdominal cavity.

If you have an enlarged spleen, avoid contact sports — such as soccer, football and hockey — and limit other activities as recommended by your doctor. Modifying your activities can reduce the risk of a ruptured spleen.

It's also important to wear a seat belt. If you're in an accident, a seat belt can help prevent injury to your spleen.