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Differential Diagnosis




The spleen should not be palpable after 3 or 4 years of age.

Below is an abdominal film (patient is erect) taken of a child who presented with massive hepatosplenomegaly. #1 points to the liver, #2 points to the spleen and #3 shows bowel loops that have been displaced inferiorly by the organomegaly. This child had T cell acute lymphoblastic leukemia.

Differential Diagnosis of Splenomegaly:

Congenital vs Acquired

Cysts Rarely causes mass like abdominal swelling


Hemolytic anemias
  • Thalassemia
  • Sickle cell disease (splenic sequestration)
  • Hereditary spherocytosis
Storage diseases
  • Gaucher disease
  • Niemann- Pick Disease
Osteopetrosis Extramedullary hematopoiesis


  • Serum sickness
  • Graft versus Host disease
Connective Tissue Disease (rheumatoid arthritis)
Infectious Viral (EB virus, CMV, HIV, hepatitis A, B & C)
Bacterial (acute and chronic systemic infection, TB, subacute endocarditis, abscess, typhoid fever).
Rickettsial (Rocky Mountain Spotted fever)
Protozoal infection (malaria, toxoplasmosis)
Fungal Infection (systemic candidiasis, histoplasmosis, coccidiomycosis)
Trauma Hemorrhage in spleen Subcapsular hematoma hemangioma, lymphangioma



Infiltrative with

leukemia, lymphoma (Hodgkin and NHL)

  • Hemangioma
  • Lymphangioma
Langerhans cell histiocytosis
Systemic Myeloproliferative disorders Polycythemia vera
Congestive splenomegaly
  • Intrahepatic portal hypertension
  • Liver cirrhosis
Pre-hepatic or portal vein obstruction


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