What is visible on her abdominal CT?
Our patient had sarcoidosis
There are many causes of splenomegaly; it can be in response to increased workload as in hemolytic anemia or infection, congestion due to portal hypertension and infiltrative diseases like leukemias, lymphomas or sarcoid.
In developed countries the most common cause of splenomegaly is infectious mononucleosis, cancer or portal hypertension. In the third world, malaria is a common cause. Causes of massive splenomegaly are fewer with : visceral leishmaniasis, cml, myelofibrosis , malaria and lymphoma heading the list.
In our patient, splenic vein thrombosis was noted in addition to splenomegaly. Hematologic malignancies were considered but she had no monoclonal protein, and bone marrow showed no blasts. A percutanous spleen biopsy showed non-caseating granulomas andACE was elevated to 151. She was started on lovenox for the splenic vein thrombosis which was thought secondary to inflammation and is being followed to institute immune suppression for her sarcoid.
Teaching points: The enlarged spleen can be associated with a friction rub or a systolic murmur. The spleen enlarges diagonally toward the LLQ and the kidney enlarges inferiorly. In the age of ultrasound the enlarged spleen is easily diagnosed. It is important to diagnose splenomegaly because it can be associated with spontaneous rupture.
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