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Differential Diagnosis Many of the diseases associated with splenomegaly are listed in Table 60-2. They are grouped according to the presumed basic mechanisms responsible for organ enlargement: 1. Hyperplasia or hypertrophy related to a particular splenic function such as reticuloendothelial hyperplasia (work hypertrophy) in diseases such as hereditary spherocytosis or thalassemia syndromes that require removal of large numbers of defective red blood cells; immune hyperplasia in response to systemic infection (infectious mononucleosis, subacute bacterial endocarditis) or to immunologic diseases (immune thrombocytopenia, SLE, Felty's syndrome). 2. Passive congestion due to decreased blood flow from the spleen in conditions that produce portal hypertension (cirrhosis, BuddChiari syndrome, congestive heart. | Chapter 060. Enlargement of Lymph Nodes and Spleen Part 7 Differential Diagnosis Many of the diseases associated with splenomegaly are listed in Table 60-2. They are grouped according to the presumed basic mechanisms responsible for organ enlargement 1. Hyperplasia or hypertrophy related to a particular splenic function such as reticuloendothelial hyperplasia work hypertrophy in diseases such as hereditary spherocytosis or thalassemia syndromes that require removal of large numbers of defective red blood cells immune hyperplasia in response to systemic infection infectious mononucleosis subacute bacterial endocarditis or to immunologic diseases immune thrombocytopenia SLE Felty s syndrome . 2. Passive congestion due to decreased blood flow from the spleen in conditions that produce portal hypertension cirrhosis Budd- Chiari syndrome congestive heart failure . 3. Infiltrative diseases of the spleen lymphomas metastatic cancer amyloidosis Gaucher s disease myeloproliferative disorders with extramedullary hematopoiesis . Table 60-2 Diseases Associated with Splenomegaly Grouped by Pathogenic Mechanism Enlargement Due to Increased Demand for Splenic Function Enlargement Due to Abnormal Splenic or Portal Blood Flow Reticuloendothelial system hyperplasia for removal of defective erythrocytes Spherocytosis Early sickle cell anemia Cirrhosis Hepatic vein obstruction Portal vein obstruction intrahepatic or extrahepatic Cavernous transformation of the Ovalocytosis Thalassemia major Hemoglobinop athie s Paroxysmal nocturnal hemoglobinuria Pernicious anemia Immune hyperplasia Response to infection viral bacterial fungal parasitic Infectious mononucleosis AIDS Viral hepatitis Cytomegalovirus Subacute bacterial endocarditis portal vein Splenic vein obstruction Splenic artery aneurysm Hepatic schistosomiasis Congestive heart failure Hepatic echinococcosis Portal hypertension any cause including the above Banti s disease Infiltration of the Spleen Intracellular or extracellular .
