🩸 Chapter 535 · Splenomegaly

Nelson Textbook of Pediatrics 22nd Edition | Splenomegaly is a common finding in many pediatric disorders. Causes: infection (EBV, CMV, malaria, bacterial endocarditis), hemolytic anemias (hereditary spherocytosis, sickle cell disease), portal hypertension (liver disease, extrahepatic portal vein obstruction), storage diseases (Gaucher, Niemann-Pick), malignancies (leukemia, lymphoma), extramedullary hematopoiesis (thalassemia, myelofibrosis), autoimmune disorders (SLE, JIA), splenic cysts, and congestive heart failure. Hypersplenism: cytopenias (anemia, leukopenia, thrombocytopenia). Diagnosis: history, physical exam, CBC with smear, ultrasound, CT/MRI, bone marrow if indicated.

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📋 30 Clinical Scenarios — Splenomegaly

📇 High‑Yield Review Cards (Splenomegaly)

🩺 Clinical Recognition: Splenomegaly & Hypersplenism

Select a presentation for diagnostic clues and management.

📋 Stepwise Evaluation of Splenomegaly

🔑 Key Principles — Nelson Chapter 535
• Normal spleen: Not palpable in older children (palpable in 10% of normal children, especially thin). Spleen must be 2-3x normal size to be palpable.
• Hypersplenism: Splenomegaly + cytopenias (anemia, leukopenia, thrombocytopenia) + bone marrow compensatory hyperplasia. Treat underlying cause; splenectomy if refractory.
• Causes by category: Infectious (EBV, CMV, malaria, bacterial endocarditis), hemolytic (HS, sickle cell, thalassemia), congestive (portal hypertension, heart failure), infiltrative (Gaucher, Niemann-Pick, leukemia, lymphoma), inflammatory (SLE, JIA, sarcoidosis).
• Imaging: Ultrasound confirms splenomegaly, evaluates liver and portal vein. CT/MRI for mass lesions or trauma.
• Splenic cyst: Congenital (epidermoid) or acquired (pseudocyst after trauma). Usually asymptomatic; surgery if large or symptomatic.

    ⚡ Reflex Prompts — Clinical Decisions in Splenomegaly

    📖 Summary: Splenomegaly — Nelson Chapter 535