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Tests and diagnosis
By Mayo Clinic staffAn enlarged spleen is usually detected during a physical exam. Your doctor can often feel the enlargement by gently examining your left upper abdomen, just under your rib cage. Keep in mind that some people, especially those who are slender, may have healthy, normal-sized spleens that can be felt during an exam.
The diagnosis is usually confirmed with blood tests and an imaging study of your abdomen, such as an ultrasound or computerized tomography (CT) scan. These tests can help determine the size of your spleen and whether it's crowding other organs. Magnetic resonance imagining (MRI) may be used to trace blood flow through the spleen.
In general, you don't need any special preparation for an ultrasound or MRI. If you're having a CT scan, however, you may need to refrain from eating before the test. If you need to prepare, your doctor will let you know well in advance.
Finding the cause
Sometimes you may need further testing to identify what's causing an enlarged spleen, including liver function tests and a bone marrow exam, which can give more detailed information about your blood cells than can blood drawn from a vein.
In some cases, a sample of solid bone marrow is removed in a procedure called a bone marrow biopsy. Or, you may have a bone marrow aspiration, which removes the liquid portion of your marrow. In many cases, both procedures are performed at the same time (bone marrow exam).
Both the liquid and solid bone marrow samples are frequently taken from the same place on the back of one of your hipbones. A needle is inserted into the bone through an incision. Because bone marrow tests are painful, you'll receive either general or local anesthesia before the test.
- Johnson HA, et al. Massive Splenomegaly. Surg Gynecol Obstet. 1989 Feb;168(2):131-7, http://www.ncbi.nlm.nih.gov/pubmed/2911790. Accessed July 15, 2008.
- Splenomegaly. Merck Manuals Online Medical Library. November 2005, http://www.merck.com/mmhe/sec14/ch179/ch179b.html. Accessed July 15, 2008.
- Patient Information for Spleen Removal (Splenectomy) from SAGES. The Society of American Gastrointestinal and Laparoscopic Surgeons, http://www.sages.org/sagespublication.php?doc=PI12.
- Chronic Myloproliferative Disorders. National Cancer Institute, http://cancernet.nci.nih.gov/templates/doc.aspx?viewid=0edcce21-e137-437f-82d6-7f81a60337e0&version=1&allpages=1. Accessed July 15, 2008.
- The Spleen. Journal of the American Medical Association. http://jama.ama-assn.org/cgi/reprint/294/20/2660.pdf. Accessed July 15, 2008.
- Martin MB, et al. Thalassemia and the Spleen. The Cooley's Anemia Foundation. http://www.cooleysanemia.org/updates/Spleen1.pdf. Accessed July 15, 2008.
- Splenomegaly. Merck Manuals Online Medical Library, http://www.merck.com/mmpe/sec11/ch138/ch138b.html. Accessed July 15, 2008.
