Massive Splenomegaly (Greater than 5 Fingers)

CLINICAL DIAGNOSTIC MANUAL

Massive splenomegaly refers to a significant enlargement of the spleen, palpable more than five fingers below the left costal margin. This degree of splenomegaly indicates a severe and generally chronic pathological condition that substantially affects spleen function.

Massive splenomegaly may be indicative of haematological, infectious, and systemic disorders requiring immediate evaluation and treatment. Recognising the underlying cause is essential for appropriate patient management.

Condition	Symptoms and Clinical Signs	Suspicion Diagnosis	Confirmatory Diagnosis
Chronic Myeloid Leukaemia	Fatigue, weight loss, night sweats, fever, pain or fullness in the left upper quadrant, easy bruising, anaemia	Clinical history, clinical symptoms	Complete blood count, peripheral blood smear, bone marrow biopsy
Myelofibrosis	Fatigue, weight loss, night sweats, fullness or pain in the left upper quadrant, anaemia, recurrent infections, bleeding	Clinical history, clinical symptoms	Complete blood count, bone marrow biopsy
Malaria	Intermittent fever, chills, sweating, headache, abdominal pain, massive splenomegaly, anaemia, jaundice	Travel history to endemic areas, clinical symptoms	Peripheral blood smear, rapid diagnostic tests for malaria
Kala-azar (Visceral Leishmaniasis)	Prolonged fever, weight loss, fatigue, massive splenomegaly, hepatomegaly, anaemia, pancytopenia, skin hyperpigmentation	Clinical history, clinical symptoms	Serology for leishmaniasis, bone marrow aspiration