Chapter 060. Enlargement of Lymph Nodes and Spleen (Part 7)

Differential DiagnosisMany 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 splenicfunction 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, Feltys syndrome).2.Passive congestion due to decreased blood flow from thespleen in conditions that produce portal hypertension (cirrhosis, BuddChiari syndrome, congestive heart...
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Chapter 060. Enlargement of Lymph Nodes and Spleen (Part 7) 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 fororgan 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, Feltys 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, Gauchers disease, myeloproliferative disorders with extramedullary hematopoiesis). Table 60-2 Diseases Associated with Splenomegaly Grouped byPathogenic Mechanism Enlargement Due to Enlargement Due to AbnormalIncreased Demand for Splenic Splenic or Portal Blood FlowFunction Reticuloendothelial system Cirrhosishyperplasia (for removal of defective Hepatic vein obstructionerythrocytes) Portal vein obstruction, intrahepatic Spherocytosis or extrahepatic Early sickle cell anemia Cavernous transformation of the Ovalocytosis portal vein Thalassemia major Splenic vein obstruction Hemoglobinopathies Splenic artery aneurysm Paroxysmal nocturnal Hepatic schistosomiasishemoglobinuria Congestive heart failure Pernicious anemia Hepatic echinococcosis Immune hyperplasia Portal hypertension (any cause Response to infection (viral, including the above): Bantis diseasebacterial, fungal, parasitic) Infiltration of the Spleen Infectious mononucleosis AIDS Intracellular or extracellular depositions Viral hepatitis Amyloidosis Cytomegalovirus Gauchers disease Subacute bacterialendocarditis Niemann-Pick disease Bacterial septicemia Tangier disease Congenital syphilis Hurlers syndrome and other mucopolysaccharidoses Splenic abscess Hyperlipidemias Tuberculosis Benign and malignant cellular Histoplasmosis infiltrations Malaria Leukemias (acute, chronic, Leishmaniasis lymphoid, myeloid, monocytic) Trypanosomiasis Lymphomas Ehrlichiosis Hodgkins disease Disordered immunoregulation Myeloproliferative syndromes (e.g., polycythemia vera, essential Rheumatoid arthritis (Feltys thrombocytosis)syndrome) Angiosarcomas Systemic lupuserythematosus Metastatic tumors (melanoma is most common) Collagen vascular diseases Serum sickness Eosinophilic granuloma Immune hemolytic anemias Histiocytosis X Immune thrombocytopenias Hamartomas Immune neutropenias Hemangiomas, fibromas, ...