When the spleen is healthy and of the normal size, it cannot be felt by pressing on the abdomen. If the spleen is abnormally large, it may be detectable during a physical exam. However, medical imaging tests should still be done to confirm the size of the spleen.
The patient should be lying down, either on their back or on their right side, for the physical examination of the spleen. This posture allows the abdomen to be partially relaxed and the spleen to shift position, making it easier to detect any enlargement. The doctor will ask the patient to take a deep breath and feel the outline of the spleen. It is only possible to feel a normal spleen in 3% of cases.
Once the diagnosis is verified through imaging examinations, healthcare professionals may require few additional tests to cross off the potential illnesses from the list mentioned above. These tests include:
- A complete blood count to rule out infections, anemia, and platelet alterations
- Liver function tests to rule out liver disease, which is usually associated with splenomegaly
- A CT scan to evaluate the presence of a splenic abscess and cancer
- Rheumatologic panel, because the rheumatic condition is one of the causes of splenomegaly
The origin of splenomegaly should be determined based on the type of illness. People with fever and skin rash should check for leukemia and other issues related to blood. In contrast, those who do not have fever and rash might have hemolytic anemia if they have jaundice or polycythemia vera if not.
Things to consider in case of splenomegaly
- Splenomegaly is not as common as hepatomegaly, and it is a more dangerous problem because a swollen spleen is more susceptible to splenic rupture.
- The most common cause of splenomegaly in immunocompromised children is a splenic abscess. Other causes in the pediatric population include congenital hemolytic anemia, Gaucher’s disease, and others.
- Complying with drug therapy is particularly important in these cases, and most patients with splenomegaly should be cautious with infections. In some cases, the immune system is deeply compromised and may lead to further alterations.