Enlarged Spleen

What is an enlarged spleen (splenomegaly)?

Your spleen is a normally fist-sized organ that’s located on the upper left side of your abdomen, under your left ribcage. Your spleen belongs to your lymphatic system and your immune system. It filters your blood, removes waste products and produces white blood cells to fight infections. Conditions affecting the spleen itself or the blood that passes through it can cause it to become swollen and enlarged.

A normal, healthy spleen is up to 12 cm long and 70 g in weight. An enlarged spleen may be up to 20 cm long and can weigh more than 1,000 g. Several things can cause your spleen to enlarge, including inflammation, fat storage, pooled blood, benign or malignant growths and overproduction of cells. Some causes are temporary and others may indicate a chronic or progressive condition.

Is an enlarged spleen serious?

An enlarged spleen is a symptom of many different conditions, some more serious than others. Your healthcare provider will need to investigate the underlying cause to determine if you need treatment. If an enlarged spleen goes untreated for a long time, it could eventually begin to malfunction. In rare cases, a severely enlarged spleen could rupture, which could cause internal bleeding.

What are the symptoms of an enlarged spleen?

You may not be able to tell if you have an enlarged spleen. If you do have symptoms, they might include:

• Upper left abdominal pain. It may also radiate to your left shoulder or back.
• Palpable spleen. You usually can’t feel your spleen with your hand, unless it’s enlarged.
• Loss of appetite or early fullness. Your enlarged spleen might encroach on your stomach below.

If your spleen is beginning to malfunction, you may notice:

• Symptoms of anemia, such as weakness and fatigue.
• More frequent colds or infections.
• Easy bleeding and bruising.

What are the most common causes of an enlarged spleen?

Common causes include:

• Infections. Viral infections such as mononucleosis and HIV, bacterial infections such as tuberculosis and endocarditis and parasite infections such as malaria and toxoplasmosis stress the immune function of the spleen. They can cause it to overproduce antibodies and immune cells (hyperplasia).
• Liver disease. Conditions affecting the liver, such as chronic hepatitis or cirrhosis, can cause pressure to build up in the blood vessels that run through the liver and spleen (portal hypertension). Vascular pressure can cause blood to pool and cause your spleen to enlarge.

Other possible causes include:

• Cancer. Blood cancers such as leukemia or myeloproliferative neoplasms (MPNs) and lymphomas can infiltrate the spleen with foreign cells that continue to multiply.
• Focal lesions. Benign growths such as a cyst or abscess, as well as metastatic cancer that spreads from somewhere else, can enlarge the spleen.
• Autoimmune diseases. Chronic inflammatory conditions such as lupus, sarcoidosis and rheumatoid arthritis can cause an overactive immune response and spleen hyperplasia.
• Blood disorders. Conditions such as hemolytic anemia and neutropenia that cause early destruction of red blood cells can overload the spleen, whose job is to remove them.
• Inherited metabolic disorders. Conditions that cause various substances to build up in your blood and store in your organs, such as Niemann-Pick disease, Gaucher disease and sickle cell disease, can infiltrate the spleen.
• Thrombosis. A blood clot that blocks one of the vessels in your liver or spleen can cause pressure and blood to build up in your spleen.

What are the possible complications of an enlarged spleen?

• Tissue death. A severely enlarged spleen may outgrow its own blood supply. When blood can’t reach the tissues, they will stop functioning or die.
• Hypersplenism. An enlarged spleen may become overactive, trapping or removing too many blood cells from circulation. This can lead to anemia, low white blood cell count or low platelet count.
• Rupture. An enlarged spleen may in rare cases spontaneously rupture or may rupture due to a direct impact, such as a blow or a fall. A ruptured spleen can be life-threatening.

How is an enlarged spleen (splenomegaly) diagnosed?

You might come to your healthcare provider with symptoms of vague abdominal discomfort, or you might have symptoms related to your underlying condition. Sometimes, healthcare providers find an enlarged spleen by accident during a routine exam, or while looking for something else. Your provider will likely be able to feel your enlarged spleen during a physical exam. It can also show up in imaging.

You may have various medical tests to confirm an enlarged spleen and help isolate the cause, including:

• Imaging tests. An abdominal ultrasound or CT scan can help confirm an enlarged spleen and may give additional information, such as how severe it is, whether it has a lesion or whether it is encroaching on any other organs. An MRI can trace the blood flow through your spleen.
• Blood tests. If your healthcare provider is unsure of the cause, they may investigate with blood tests. They can test for specific diseases, cancers, blood disorders and liver function problems.
• Bone marrow analysis. Your provider might take a bone marrow aspiration and/or bone marrow biopsy to test the blood cell content in your bone marrow tissues. This can give them information about how your spleen is functioning and can indicate certain disorders.

How do you treat an enlarged spleen?

In many cases, the spleen will return to normal size as the underlying condition improves. Some conditions, such as transient infections, may go away by themselves. Your provider may treat other conditions with medication, blood treatments or surgery. Some have no cure. In these cases, healthcare providers may treat your enlarged spleen with low-dose radiation therapy to reduce it, or surgery to remove it.

What are the side effects of having your spleen removed?

You can live well without your spleen, but you will have reduced immunity to infections. Your healthcare provider will recommend certain vaccines to protect you against some of the most common infections you may be more vulnerable to. They will recommend you wear a medical ID bracelet alerting medical professionals to your absent spleen. They may prescribe stronger antibiotics when you do get sick.

How should I take care of myself if I have an enlarged spleen?

If you have a chronically enlarged spleen, be careful to avoid trauma to your abdomen. An enlarged spleen is more vulnerable to rupture. It's best to avoid high-contact sports. Your spleen may also be at risk of losing its functionality, or of becoming overactive. Look out for signs of anemia, such as paleness and fatigue. Your healthcare provider may want to check your blood levels periodically.

Are there particular foods to avoid with an enlarged spleen?

Healthcare providers aren’t sure if your diet directly affects your spleen, but it does affect your overall health. If you have an enlarged spleen, you can consider yourself immunocompromised. A healthy diet is one of the easiest ways to help protect your immunity. It may also influence the underlying health conditions that are causing your enlarged spleen, especially inflammatory conditions and liver disease.

Healthcare providers will always recommend that you avoid or minimize fast and processed foods, including packaged snacks, sweets and deli meats. These foods are highly inflammatory, and they promote LDL cholesterol, which is bad for your liver and metabolism. An anti-inflammatory diet emphasizes fresh, whole foods and unsaturated fats, such as those found in fish and nuts.

When should I seek care for my enlarged spleen?

If you notice increased pain in the area of your spleen or your left shoulder, especially if it's worse when you breathe in, seek medical attention right away. A rupture is more likely to happen after an impact to your abdomen, but sometimes it happens by itself. Even a small rupture and a slow bleed can suddenly become urgent if it isn’t treated in time. Earlier treatment may also prevent the need for surgery.

A note from Cleveland Clinic

An enlarged spleen is a symptom that healthcare providers need to investigate. Whether or not it’s causing you discomfort, it indicates an underlying condition that may need treatment. When it’s temporary, an enlarged spleen won’t harm your overall health. But chronic swelling could damage and endanger your spleen. Your healthcare provider will treat it by treating the underlying cause.