A palpable spleen is not necessarily enlarged or pathological

Area of Science:

• Radiology
• Nuclear Medicine
• Gastroenterology

Background:

• The common clinical belief is that a palpable spleen in adults signifies enlargement and pathology.
• This belief often leads to further investigations for splenomegaly.

Purpose of the Study:

• To evaluate the accuracy of the clinical assumption that a palpable spleen is always pathological.
• To establish a reliable upper limit for normal splenic size using scintigraphy.

Main Methods:

• Review of 1600 technetium-99m sulfur colloid liver-spleen scintigraphy studies.
• Analysis of 21 patients with palpable spleens but scintigraphic size ≤13 cm posterior length.
• Postmortem examination of 123 spleens from liver-spleen scans to correlate size and weight with normality.

Main Results:

• 18 out of 21 patients with palpable spleens (≤13 cm posterior length) showed no evidence of splenic disease on follow-up.
• Postmortem analysis confirmed that spleens ≤13 cm posterior length (98%) weighed ≤250 g and were histologically normal.
• A splenic size of 13 cm posterior length or less was identified as a reliable indicator of a normal-sized spleen.

Conclusions:

• Palpability of the spleen does not invariably indicate splenomegaly or disease.
• A splenic size of 13 cm posterior length or less on scintigraphy is a reliable indicator of a normal spleen.
• Clinical assessment of splenic palpability should be interpreted in conjunction with imaging findings.