November 10, 1993

Does This Patient Have Splenomegaly?

Author Affiliations

From the Divisions of General Internal Medicine, Gastroenterology, and Clinical Epidemiology, Montreal General Hospital and the Departments of Medicine and Epidemiology and Biostatistics, McGill University, Montreal, Quebec (Drs Grover and Barkun); and the Division of General Internal Medicine, Department of Medicine and the Department of Clinical Epidemiology and Biostatistics of McMaster University and Henderson General Hospital, Hamilton, Ontario (Dr Sackett). Dr Grover is a research scholar and Dr Barkun is a clinical scholar supported by the Fonds de la recherche en santé du Quebec.

JAMA. 1993;270(18):2218-2221. doi:10.1001/jama.1993.03510180088040

THREE PATIENTS  Among the patients you are seeing today are the following three:The first is an elderly woman who complains of easy fatigability, and her conjunctivae and nail beds are pale. You suspect that she is anemic due to gastrointestinal blood loss, but among your differential diagnoses you consider a lymphoproliferative disorder and decide to examine her for splenomegaly.The second is a college student with failing appetite, ability to concentrate, energy, and grades. You think that he is depressed but want to rule out infectious mononucleosis and decide to examine him for splenomegaly.The third is an otherwise healthy, well-controlled, hypertensive male with a normal cardiovascular examination. As he lies on the examining table, stripped to his waist, you wonder whether you should take the time to examine him for splenomegaly.

WHY EXAMINE THE SPLEEN?  We examine the spleen to see whether it is palpable. Most palpable spleens