Splenomegaly, or enlarged spleen, often develops without noticeable symptoms. In some cases, people may experience abdominal pain or a feeling of fullness after eating only a small amount of food. Normally, the spleen is about the size of a fist, but it can nearly double in size when enlarged.

Many different conditions can cause splenomegaly, including infections, liver disease, autoimmune disorders, and blood-related conditions. Treatment usually focuses on addressing the underlying cause and may involve rest, medication, surgery, or radiation.

Splenomegaly Symptoms

Many people with splenomegaly do not have symptoms. When symptoms do appear, they may include:

Abdominal Pain Or Fullness
The spleen is located in the upper left abdomen. Enlargement can cause pain or a sense of fullness in this area.

Early Fullness
When the enlarged spleen presses on the stomach, you may feel full after eating only small amounts.

Hiccups
An enlarged spleen can irritate the diaphragm, which may trigger hiccups.

Palpable Spleen
Normally, you cannot feel your spleen from outside the body. If it becomes enlarged, it may be noticeable when pressing below the left ribcage.

As splenomegaly worsens, additional symptoms may develop:

  • Easy bruising and bleeding

  • Frequent infections

  • Weakness, fatigue, or shortness of breath due to anemia

What Causes Splenomegaly?

The spleen is an important organ in the upper left abdomen, just under the ribcage. It filters blood, removes old or damaged red blood cells, and produces white blood cells to fight infection. Splenomegaly occurs when another condition interferes with these functions and causes the organ to enlarge.

Possible causes include:

  • Autoimmune diseases such as lupus or rheumatoid arthritis

  • Blood disorders like sickle cell anemia or neutropenia

  • Blood cancers such as leukemia or Hodgkin lymphoma

  • Infections including mononucleosis, malaria, or tuberculosis

  • Liver disease such as cirrhosis or chronic hepatitis

  • Metabolic disorders like Gaucher disease or Niemann-Pick disease

  • Thrombosis (blood clots) that block blood flow to or from the spleen

Risk Factors

Certain factors can raise the risk of developing an enlarged spleen, including:

  • Heavy alcohol use

  • Intravenous drug use

  • Living in or traveling to regions where malaria is common

  • Family or personal history of liver disease, splenomegaly, blood disorders, or cancer

  • Recent infections such as mononucleosis

Types Of Splenomegaly

Splenomegaly is sometimes classified based on the underlying cause:

  • Congestive splenomegaly: Caused by increased pressure in the portal vein, often linked to liver disease or heart failure.

  • Infectious splenomegaly: Caused by infections such as mononucleosis.

  • Infiltrative splenomegaly: Develops when abnormal proteins or substances build up inside the spleen.

  • Inflammatory splenomegaly: Linked to autoimmune or inflammatory conditions.

  • Neoplastic splenomegaly: Caused by tumor growth in the spleen, which may be benign or malignant.

How Is Splenomegaly Diagnosed?

Splenomegaly may be detected during a physical exam when the spleen can be felt in the upper left abdomen. Normally, it is not palpable unless enlarged.

Size classifications include:

  • Normal spleen: up to 12 cm, 70–200 g

  • Splenomegaly: 12–20 cm, 400–500 g

  • Massive splenomegaly: over 20 cm, more than 1,000 g

Diagnostic tests may include:

  • Blood tests: To check for anemia, infection, or blood abnormalities

  • Bone marrow biopsy: To detect cancers or blood disorders

  • Imaging tests (ultrasound, CT, MRI): To measure spleen size and look for abnormalities

  • Liver or spleen biopsy: To check for tumors or liver disease

Treatment

Treatment focuses on addressing the underlying cause so the spleen can return to normal size. For example, bacterial infections may be treated with antibiotics, which often reduce spleen enlargement.

When splenomegaly is due to chronic or untreatable conditions, treatment may include:

  • Low-dose radiation therapy: To shrink the spleen and relieve symptoms

  • Surgery (splenectomy): Removal of the spleen if symptoms are severe or caused by tumors

Prevention

Splenomegaly itself cannot always be prevented, but managing underlying health conditions may lower the risk.

For people with splenomegaly:

  • Avoid contact sports to reduce the risk of spleen rupture

  • Visit your healthcare provider regularly for monitoring

  • Stay current on vaccinations to reduce the risk of infections

Complications

If untreated, splenomegaly may lead to serious complications:

  • Anemia: Caused by insufficient red blood cell production

  • Increased risk of infection: Due to fewer white blood cells

  • Ruptured spleen: A medical emergency often caused by trauma or injury to the abdomen

A Quick Review

Splenomegaly is an enlarged spleen that may cause no symptoms or lead to abdominal pain, early fullness, hiccups, and fatigue.

Causes include infections, liver disease, autoimmune disorders, blood disorders, and cancer. Treatment depends on the underlying condition and may involve medication, surgery, or radiation.

Left untreated, splenomegaly can result in serious complications, including anemia, infection, or rupture of the spleen. If you feel pain in your upper left abdomen — especially if it worsens with breathing — seek medical care.