SPLENOMEGALY IN 2,505 PATIENTS AT A LARGE UNIVERSITY MEDICAL-CENTER FROM 1913 TO 1995 - 1963 TO 1995 - 449 PATIENTS

Splenomegaly was studied retrospectively at the University of Californ ia, San Francisco (UCSF), School of Medicine in 301 patients from 1963 to 1995 and compared with the UCSF service of the San Francisco Gener al Hospital Medical Center (SFGH) in 148 patients from 1979 to 1994. T he combined 449 patients were classified into several diagnostic group s and were studied by means of several clinical and laboratory associa tions. Hepatic disease in the percentage of patients at UCSF (with tho se at SFGH given in parentheses) was associated with splenomegaly in 2 9% (41%), hematologic disease, 32% (16%); infectious diseases, 16% (36 %); congestive or inflammatory diseases, 10% (4%); primary splenic dis ease, 6% (1%); other, 5% (1%); and cause unknown, 2% (1%). Massive spl enomegaly occurred in 27% of the patients of the combined series, part icularly in patients with hematologic diseases. The acquired immunodef iciency syndrome (AIDS) occurred in more than half of the patients wit h infectious diseases at SFGH and was four times more frequent than in the patients at UCSF. The commonest diseases associated with splenome galy were hematologic (lymphoma), hepatic (chronic liver disease), inf ectious diseases (AIDS and endocarditis), congestive (congestive heart failure), primary splenic (splenic vein thrombosis), and other (malig nancy not metastatic to the spleen). In 11 patients with AIDS and mass ive splenomegaly, Mycobacterium avium complex occurred in 8 (73%). Spl enectomy was performed in 117 patients (26%), primarily for hematologi c amelioration. I conclude that for splenomegaly of unknown origin, th e invasive procedure of choice for patients with hematologic associati ons may be a bone marrow biopsy; for hepatic associations, a liver bio psy; and for infectious disease associations, a lymph node biopsy, bef ore any consideration of a diagnostic splenectomy.