Research Article
BibTex RIS Cite

Splenomegaly in Childhood

Year 2013, Volume: 1 Issue: 1, 10 - 16, 01.04.2013

Abstract

Splenomegaly in childhood is generally first suspected upon physical examination.Spleen is palpable in %15 of neonates and %10 of normal children.The normal spleen is less than 1-2 cm below the left costal margin.An anlarged spleen is often firm and may have abnormal surface. The etiology of splenomegaly varies with age and differential diagnoses of splenomegaly is extensive but careful history taking and physical examination, along with a CBC count and liver function tests, often help in narrowing the list of differential diagnoses Malaria, schistosomiasis, and other infections in endemic areas are frequent causes of splenomegaly and Splenic rupture may occur in acute splenomegaly associated with infectiousmononucleosis. The goal of treatment is to treat the underlying disease but splenectomy is uncommonly performed in children with splenomegaly and postsplenectomysepsis is the most important mortal complication. Benefits must be carefully weighed when splenectomy is being considered. The new PCV7 conjugated pneumococcal vaccine and the older PPV23 polyvalent pneumococcal vaccines and the Haemophilus influenzae vaccine should be administered to all children who are asplenic and to those about to undergo splenectomy.

References

  • Arkles LB, Gill GD, Molan MP. A palpable spleen is not necessarily enlarged or pathological. Med J 1986;145(1):15-7.
  • 2,Philip Lanzkowsky Manual of Pediatric Hematology and Oncology (Fifth Edition), 2011, P 461-471
  • Hilmes MA, Strouse PJ. The pediatric spleenSemin Ultrasound CT MR. 2007 Feb;28(1):3-11.
  • From Rosenberg HK, et al. AJR Am J Roentgenol 1991:157:119 –121
  • Brown NF, Marks DJ, Smith PJ, Bloom SL. Splenomegaly. Br 2011;72(11):M166-9.
  • Grover SA, Barkun AN, Sackett DL: Does this patient have splenomegaly? JAMA 1993;270:2218-21
  • Sills RH. Splenic function: physiology and splenic hypofunction. Crit Rev Oncol Hematol. 1987;7(1):1-36.
  • Chadburn A: The spleen: anatomy and anatomical function. Semin Hematol 2000; 37: 13-21.
  • Steininger B, Barth P: Microanatomy and function of the spleen. Adv Anat Embryol Cell Biol 2000; 151:1- 101
  • Russel RCG, Williams NS, Bulstrode CJK, ailey&LoBve's Short Practice.(23 th edition ) Oxford Universty Press (2000) 953-964, 1296-1306
  • Sayek İ. Dalak yapı ve fonksiyonları. Temel cerrahi. (1994) cilt-I.1033-1040
  • Mebius RE, Kraal G. Structure and function of the spleen. Nat Rev Immunol. Aug 2005;5(8):606-16.
  • 13 McIntyre OR, Ebaugh FG. Palpable spleens in college freshmen. Ann Intern Med. Feb 1967;66(2):301 - 6 Hosp Med
  • (Lond) 14.Ebaugh FG, McIntyre OR. Palpable spleens: ten-year follow-up. Ann Intern Med. Jan 1979;90(1):130-1.
  • Genton B, al-Yaman F, Beck HP, et al. The epidemiology of malaria in the Wosera area, East Sepik Province, Papua New Guinea, in preparation for vaccine trials. I. Malariometric indices and immunity. Ann Trop Med Parasitol. Aug 1995;89(4):359-76.
  • Sarin SK, Kapoor D. Non-cirrhotic portal fibrosis: current concepts and management. J Gastroenterol Hepatol. May 2002;17(5):526-34
  • Pochedly C, Sills RH, Schwartz AD, eds. Disorders of the Spleen: Pathophysiology and Management. New York, NY: Marcel Dekker; 1989.
  • Farley DR, Zietlow SP, Bannon MP, Farnell MB. Spontaneous rupture of the spleen due to infectious mononucleosis. Mayo Clin Proc. Sep 1992;67(9):846-53. 19. DB. Acquired platelet defects. In: Nathan DG, Orkin SH, Ginsburg D, Look AT. Nathan and Oski's hematology of infancy and childhood. Vol 2. 6th ed. Philadelphia, PA: WB Saunders; 2003:1599.
  • Peck-Radosavljevic
  • Gastroenterol Hepatol. 2001;13(4):317-23 Hypersplenism. Eur
  • J Castagnola E, Fioredda F. Prevention of life- threatening infections due to encapsulated bacteria in children with hyposplenia or asplenia: a brief review of current recommendations for practical purposes. Eur J Haematol. Nov 2003;71(5):319-26.
  • Price VE, Dutta S, Blanchette VS, Butchart S, Kirby M, Langer JC, et al. The prevention and treatment of bacterial infections in children with asplenia or hyposplenia: practice considerations at the Hospital for Sick 2006;46(5):597-603
  • Tunnessen WW Jr. Splenomegaly. In: Roberts K, Tunnessen W, eds. Signs and Symptoms in Pediatrics. 3rd ed. Philadelphia, PA: Lippincott Williams and Wilkins; 1999:475-83.
  • Nixon RK Jr. The detection of splenomegaly by percussion. N Engl J Med. Jan 28 1954;250(4):166-7.
  • Castell DO. The spleen percussion sign. A useful diagnostic technique. Ann Intern Med. 1967;67(6):1265- 7. Blood
  • Cancer 26.Grover SA, Barkun AN, Sackett DL. The rational clinical
  • splenomegaly? JAMA. Nov 10 1993;270(18):2218-21.
  • Kinney TR, Ware RE, Schultz WH, Filston HC. Long- term management of splenic sequestration in children with sickle cell disease. J Pediatr. 1990;117(2 Pt 1):194-9 28.Armitage JO. Approach to the patient with lymphadenopathy and splenomegaly. In: Goldman L, Schafer AI, eds. Cecil Medicine. 24th ed. Philadelphia, PA: Saunders Elsevier; 2011:chap 171.
  • Robertson F, Leander P, Ekberg O. Radiology of the spleen. Eur Radiol. 2001;11(1):80-95.
  • Schlesinger AE, Hildebolt CF, Siegel MJ, Pilgrim TK. Splenic volume in children: simplified estimation at CT. Radiology. Nov 1994;193(2):578-80.
  • Ginzel AW, Kransdorf MJ, Peterson JJ, Garner HW, Murphey MD. Mass-like extramedullary hematopoiesis: imaging features. Skeletal Radiol. Nov 20 2011
  • Ancliff P, Hann I. Splenomegaly. In: Sills RH, ed. Practical Algorithms in Pediatric Hematology and Oncology. Basel, Switzerland: Karger; 2003:50-1. have 39. Riddington
  • antibiotics for preventing pneumococcal infection in children with sickle cell disease. Cochrane Database Syst Rev. 2002;(3):CD003427. S.
  • Prophylactic 40. Cummins, D., Heuschkel, R. & Davies, S.C. (1991)Penicillin prophylaxis in children with sickle celldisease in Brent. British Medical Journal, 302,989– 990.
  • Eichner ER. Sports medicine pearls and pitfalls-- defending the spleen: return to play after infectious mononucleosis. Curr Sports Med Rep 2007;6(2):68-9.
  • Rice SG; American Academy of Pediatrics Council on Sports Medicine and Fitness. Medical conditions affecting sports
  • participation. Pediatrics 2008;121(4):841-8.

Çocukluk Çağında Splenomegali

Year 2013, Volume: 1 Issue: 1, 10 - 16, 01.04.2013

Abstract

Çocukluk çağında splenomegali genellikle ilk olarak fizik muayenede tespit edilir. Dalak yenidoğanların %15’inde ve sağlıklı çocukların ise %10’unda kosta altında 1-2 cm ele gelir. Patolojik olarak büyümüş dalak genellikle sert ve düzensiz yüzeylidir. Splenomegali etyolojisinin yaş ile değişmesine ve ayırıcı tanısının çok geniş kapsamlı olmasına rağmen dikkatli öykü alınması, fizik muayene, tam kan sayımı ve karaciğer fonksiyon testleri genellikle ayırıcı tanı listesini oldukça kısaltır. Malarya ve Şistozomiyazis endemik bölgelerde splenomegalinin sık görülen nedenleridir. İnfeksiyöz mononükleozise bağlı akut splenomegalide splenik rüptür gelişebilir. Splenomegalide tedavinin amacı öncelikle altta yatan nedeni tedavi etmektir ancak splenektomi bazı olgularda nadiren de olsa uygulanır. Bu hastalarda postsplenektomi sepsisi en önemli ölümcül koplikasyondur bu nedenle splenektomi kararından önce faydaları dikkatlice gözden geçirilmelidir. Asplenik ya da splenektomi yapılması planlanan tüm çocuklara konjuge pnömokok, polivalan pnömokok ve Hemofilus İnfluenza aşıları yapılmalıdır

References

  • Arkles LB, Gill GD, Molan MP. A palpable spleen is not necessarily enlarged or pathological. Med J 1986;145(1):15-7.
  • 2,Philip Lanzkowsky Manual of Pediatric Hematology and Oncology (Fifth Edition), 2011, P 461-471
  • Hilmes MA, Strouse PJ. The pediatric spleenSemin Ultrasound CT MR. 2007 Feb;28(1):3-11.
  • From Rosenberg HK, et al. AJR Am J Roentgenol 1991:157:119 –121
  • Brown NF, Marks DJ, Smith PJ, Bloom SL. Splenomegaly. Br 2011;72(11):M166-9.
  • Grover SA, Barkun AN, Sackett DL: Does this patient have splenomegaly? JAMA 1993;270:2218-21
  • Sills RH. Splenic function: physiology and splenic hypofunction. Crit Rev Oncol Hematol. 1987;7(1):1-36.
  • Chadburn A: The spleen: anatomy and anatomical function. Semin Hematol 2000; 37: 13-21.
  • Steininger B, Barth P: Microanatomy and function of the spleen. Adv Anat Embryol Cell Biol 2000; 151:1- 101
  • Russel RCG, Williams NS, Bulstrode CJK, ailey&LoBve's Short Practice.(23 th edition ) Oxford Universty Press (2000) 953-964, 1296-1306
  • Sayek İ. Dalak yapı ve fonksiyonları. Temel cerrahi. (1994) cilt-I.1033-1040
  • Mebius RE, Kraal G. Structure and function of the spleen. Nat Rev Immunol. Aug 2005;5(8):606-16.
  • 13 McIntyre OR, Ebaugh FG. Palpable spleens in college freshmen. Ann Intern Med. Feb 1967;66(2):301 - 6 Hosp Med
  • (Lond) 14.Ebaugh FG, McIntyre OR. Palpable spleens: ten-year follow-up. Ann Intern Med. Jan 1979;90(1):130-1.
  • Genton B, al-Yaman F, Beck HP, et al. The epidemiology of malaria in the Wosera area, East Sepik Province, Papua New Guinea, in preparation for vaccine trials. I. Malariometric indices and immunity. Ann Trop Med Parasitol. Aug 1995;89(4):359-76.
  • Sarin SK, Kapoor D. Non-cirrhotic portal fibrosis: current concepts and management. J Gastroenterol Hepatol. May 2002;17(5):526-34
  • Pochedly C, Sills RH, Schwartz AD, eds. Disorders of the Spleen: Pathophysiology and Management. New York, NY: Marcel Dekker; 1989.
  • Farley DR, Zietlow SP, Bannon MP, Farnell MB. Spontaneous rupture of the spleen due to infectious mononucleosis. Mayo Clin Proc. Sep 1992;67(9):846-53. 19. DB. Acquired platelet defects. In: Nathan DG, Orkin SH, Ginsburg D, Look AT. Nathan and Oski's hematology of infancy and childhood. Vol 2. 6th ed. Philadelphia, PA: WB Saunders; 2003:1599.
  • Peck-Radosavljevic
  • Gastroenterol Hepatol. 2001;13(4):317-23 Hypersplenism. Eur
  • J Castagnola E, Fioredda F. Prevention of life- threatening infections due to encapsulated bacteria in children with hyposplenia or asplenia: a brief review of current recommendations for practical purposes. Eur J Haematol. Nov 2003;71(5):319-26.
  • Price VE, Dutta S, Blanchette VS, Butchart S, Kirby M, Langer JC, et al. The prevention and treatment of bacterial infections in children with asplenia or hyposplenia: practice considerations at the Hospital for Sick 2006;46(5):597-603
  • Tunnessen WW Jr. Splenomegaly. In: Roberts K, Tunnessen W, eds. Signs and Symptoms in Pediatrics. 3rd ed. Philadelphia, PA: Lippincott Williams and Wilkins; 1999:475-83.
  • Nixon RK Jr. The detection of splenomegaly by percussion. N Engl J Med. Jan 28 1954;250(4):166-7.
  • Castell DO. The spleen percussion sign. A useful diagnostic technique. Ann Intern Med. 1967;67(6):1265- 7. Blood
  • Cancer 26.Grover SA, Barkun AN, Sackett DL. The rational clinical
  • splenomegaly? JAMA. Nov 10 1993;270(18):2218-21.
  • Kinney TR, Ware RE, Schultz WH, Filston HC. Long- term management of splenic sequestration in children with sickle cell disease. J Pediatr. 1990;117(2 Pt 1):194-9 28.Armitage JO. Approach to the patient with lymphadenopathy and splenomegaly. In: Goldman L, Schafer AI, eds. Cecil Medicine. 24th ed. Philadelphia, PA: Saunders Elsevier; 2011:chap 171.
  • Robertson F, Leander P, Ekberg O. Radiology of the spleen. Eur Radiol. 2001;11(1):80-95.
  • Schlesinger AE, Hildebolt CF, Siegel MJ, Pilgrim TK. Splenic volume in children: simplified estimation at CT. Radiology. Nov 1994;193(2):578-80.
  • Ginzel AW, Kransdorf MJ, Peterson JJ, Garner HW, Murphey MD. Mass-like extramedullary hematopoiesis: imaging features. Skeletal Radiol. Nov 20 2011
  • Ancliff P, Hann I. Splenomegaly. In: Sills RH, ed. Practical Algorithms in Pediatric Hematology and Oncology. Basel, Switzerland: Karger; 2003:50-1. have 39. Riddington
  • antibiotics for preventing pneumococcal infection in children with sickle cell disease. Cochrane Database Syst Rev. 2002;(3):CD003427. S.
  • Prophylactic 40. Cummins, D., Heuschkel, R. & Davies, S.C. (1991)Penicillin prophylaxis in children with sickle celldisease in Brent. British Medical Journal, 302,989– 990.
  • Eichner ER. Sports medicine pearls and pitfalls-- defending the spleen: return to play after infectious mononucleosis. Curr Sports Med Rep 2007;6(2):68-9.
  • Rice SG; American Academy of Pediatrics Council on Sports Medicine and Fitness. Medical conditions affecting sports
  • participation. Pediatrics 2008;121(4):841-8.

Details

Primary Language Turkish
Subjects Health Care Administration
Journal Section Reviews
Authors

Nafia KAZANCI

Samet OZER

Resul YILMAZ

Erhan KARAASLAN

Publication Date April 1, 2013
Published in Issue Year 2013 Volume: 1 Issue: 1

Cite

Vancouver KAZANCI N, OZER S, YILMAZ R, KARAASLAN E. Çocukluk Çağında Splenomegali. pediatr pract res. 2013;1(1):10-6.