Non-invasive diagnosis of tropical splenomegaly syndrome

A study of 41 clinically diagnosed cases of possible tropical splenomegaly syndrome (TSS) was undertaken in Mulago Hospital, Kampala, Uganda, to determine the appropriateness of liver ultrasonography in confirming a diagnosis of TSS. Definitive diagnosis of TSS was made on liver biopsy in 35 (85%) cases. Abdominal ultrasound showed that 30 of the confirmed cases of TSS had normal liver echo-texture and portal vein diameter, and five had abnormally increased liver echo-texture. The combination of massive splenomegaly and hepatomegaly, together with normal ultrasound features of the liver was highly suggestive of TSS. The sensitivity of this criterion was 86% and the specificity was 83%. This non-invasive approach to the diagnosis of TSS is associated with less hazards than liver biopsy, and a normal echogram could be used to make the diagnosis in over 80% of cases, in the field where histopathology may be lacking.