Causes of hepatosplenomegaly

Hepatomegaly

• Malignancy
  • Primary or secondary
• Hepatic congestion
  • Right heart failure
  • Hepatic vein thrombosis (Budd-Chiari syndrome)
• Haematological
  • Lymphoma/leukaemia/myeloproliferative
• Infection
  • Infectious mononucleosis
  • Viral hepatitis
• Anatomical
  • Riedel’s lobe
• Other
  • Non-alcoholic fatty liver disease
  • Alcoholic liver disease
  • Sarcoidosis
  • Amyloidosis
  • Infective endocarditis

Splenomegaly

• Infiltration
  • Leukaemia
  • Lymphoma
  • Myeloproliferative disorders
• Increased function
  • ↑Extravascular haemolysis (haemoglobinopathy, thalassaemia, spherocytosis)
  • ↑Extramedullary haematopoiesis (myelofibrosis, malignant bone marrow infiltration)
  • ↑Response to infection (HIV/AIDS, glandular fever, infective endocarditis, malaria, autoimmune disorders)
• Vascular congestion
  • Cirrhosis (causing portal hypertension)
  • Splenic vein obstruction
  • Budd-Chiari syndrome

Hepatosplenomegaly

• Chronic liver disease with portal hypertension 
  • Any cause of chronic liver disease 
• Haematological
  • Leukaemia
  • Lymphoma
  • Myeloproliferative disorders
• Infections
  • Acute viral hepatitis
  • CMV/EBV
  • Malaria
  • Visceral leishmaniasis
• Infiltration
  • Amyloidosis
  • Sarcoidosis

Test your knowledge

What would you expect to happen to the size of the liver and spleen in liver cirrhosis?

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What are the causes of massive splenomegaly?

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Which other clinical findings may you expect to find in a patient with hepatosplenomegaly due to a haematological cause?

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