Have Enlarged Spleen. Experiencing Upper Quadrant Pain. What Could Be Causing This?

Posted on Fri, 10 May 2013

Question: Hi. My son is 19 and has had enlarged spleen (first scan 13.7 now 2 years later 14.9). He has had right upper quadrant pain x 4 years and on last u/s gall stone was found. CBC/Met C has been normal. He also has chronic enlarged mesenteric and inguinal lymph nodes. He is seeing a gastroenterologist and has a surgeon's appointment coming up this week. No one can find a reason for the spleen enlargement and really don't seem overly concerned about it. When he has pain it is severe to the point that he becomes very pale and has to pace around. His RUQ is tender even when he isn't hurting. I am very concerned (and a Hospice Nurse to boot) Am I worrying unnecessarily?

Answered by Dr. Luchuo Engelbert Bain (4 hours later)

Hi and thanks for the query,
Considering the fact he has been experiencing Right Upper Quadrant pain for some time and an increase in the size of the spleen, this could depict an evolving condition that might actually require a more critical evaluation. It would be interesting to know whether special attention or specific tests have been done with the enlarged mesenteric lymph nodes or inguinal lymph nodes? Tests like a lymph node biopsy if any.

A complete clinical and biological evaluation is compelling. Enlarged spleens as such could be seen in some cases of chronic malaria, but it's not usually associated with lymph node enlargement. Conditions like leukemias and lymphomas, both Hodgkin and Non Hodgkin lymphomas are conditions that must be excluded. A complete blood count in search of a excessive white blood cells, low hemoglobin counts could be helpful. Raised eosinophils could also be observed in some lymphomas. A lymph node biopsy in the process with histologic diagnosis in search of XXXXXXX Sternbeg cells could suggest Hodgkin lymphomas.

Specific viral infections through specific phytohemaglutinin tests and exclusion of a hyperproliferative malignant disease should be considered and systematically excluded. Liver function has to be well evaluated and signs of portal hypertension, which could lead to splenomegaly be considered.
An abdominal ultrasound and an CT scan for follow up and determining of the limits of these enlargements could be very useful.

Its a good idea the child shall be meeting the surgeon soon. However, the opinion of an internist/hematologist, at some point in the diagnostic process could also be very useful.

Thanks and best regards,
Luchuo, MD.

Above answer was peer-reviewed by : Dr. Vaishalee Punj

Follow up: Dr. Luchuo Engelbert Bain (7 hours later)

Thank you Dr. Luchuo for your reply. My son has had several CT and MRI scans and the findings come back the same. Enlarged spleen and stable if minimally enlarged from prior exam of the lymph nodes. He has been tested for HIV (routine, no XXXXXXX lifestyle, sexual or blood transfusion worries) which was negative. He appears well a lot of the time. Would Hodgkins or Non Hodgkins lymphoma show abnormalties on his CBC? His liver functions are normal. Report states that his lymph nodes are approx. 1.2 cm so they have not been biopsied but have been being followed. He has not lost weight. we have been searching for something for approx. 3 years for an answer. I feel that there is something wrong with him. (I have tried to keep my paranoia at bay, being a hospice nurse) I truly think that I am looking at these findings as a mother. I agree that I am glad that he is seeing a surgeon this coming friday, however GI is sending him for gall bladder findings. I am going armed with all reports from over the last several years (CT, MRI,Labs) and am probably going to lock this Dr. in the exam room until we get some answers. Wish this poor MD well-you know I am just kidding, i just want to know what is wrong with my son. Thank you for your time

Answered by Dr. Luchuo Engelbert Bain (54 minutes later)

Hi and thanks for the remarks.

I strongly feel results from the complete blood count guide us on the possible etiology. The lymphocyte count is important in excluding or having an idea of a possible leukemia. This might compel further tests like a infections live EBV. A lymph node biopsy is also important in excluding that this is not a lymphoma.

I suggest you visit your surgeon. However, depending on the cause, the opinion of hematologist, with a good idea of the hematopoietic system affected in this case would be very helpful.

Thanks and hope this helps.

Best regards,
Luchuo, MD.

Above answer was peer-reviewed by : Dr. Shanthi.E

Follow up: Dr. Luchuo Engelbert Bain (2 hours later)

Thank you very much for your time. Sometimes just an opinion from someone that is out of the picture can look at findings with fresh eyes. I hope you have a great day and again, thank you

Answered by Dr. Luchuo Engelbert Bain (2 hours later)

Hi and thanks for your comments,
I wish you the best and do not hesitate communicating the outcome of the child's evaluation. Getting further discussions on XXXXXXX to contribute to the Child's well being is the pleasure of the team.
Once again, thanks and kind regards,
Luchuo, MD.

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Above answer was peer-reviewed by : Dr. Raju A.T