How to overcome splenomegaly?

Question

Hi doctor,

I am a 32-year-old male. My height is 6 feet and 1 inches, and I weigh 176.37 pounds. My body is athletic, with 22 % body fat. Four years back, I was found accidentally on a routine ultrasound with a splenomegaly of 6.88 inches. I did complete blood work, and the results were normal. After three months, we repeated the ultrasound, and the spleen shrank to 5.70 inches. Since then, I have had follow-up bloodwork (FBC, Liver, ESR, LDH, PSA AST, ALT) and ultrasound. My spleen is always between 5 to 6 inches, and all the blood work is normal. In my last blood work two days ago, the only abnormality was my total bilirubin which was 1.21, which is borderline high, the ultrasound checked my liver as well, and the doctor said it was working fine. Please note I have had no unusual symptoms over the last four years except 2 to 3 colds lasting 2 to 3 days without any fever or anything like that.

My doctor says to let it go, but it says lymphoma, liver, and leukaemia whenever I read. My doctor says it should have shown over the last four years if it was something like this, either symptomatic or shown in my blood work. He says he will not prescribe more invasive testing when I have no clinical symptoms or abnormal blood tests.

Should I pursue this more? What else could it be?

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

I will get back to you after going through your case history.

Thank you.

Answer 2

Hi,

Welcome back to icliniq.com.

I have thoroughly reviewed your case history (attachments removed for patient identity protection) and understand your concern.

1) Ultrasound is an operator-dependent investigation modality, so there is a possibility that previously someone overestimated the size (this is one possibility), considering the absence of symptoms and no other significant findings on your other reports.

2) Another possibility is transient spleen enlargement secondary to any ongoing infection, which has already been resolved.

Your spleen has not shrunk; it has returned to normal now, so there is no need for further tests until symptomatic or any other major abnormality is seen on the blood report.

Thank you.

Answer 3

Hi,

Welcome back to icliniq.com.

3 to 4 inches are usually considered normal. People have minor variations per body height, weight and overall size.

Thank you.

Answer 4

Hi,

Welcome back to icliniq.com.

In case of any need, please consult with me.

Thank you.

Answer 5

Hi,

Welcome back to icliniq.com.

If your pancreas is normal on ultrasound, with no symptoms of any alarming features, I do not think you need a computed tomography scan to rule out pancreatic cancer. We usually go for a computed tomography scan abdomen with contrast (pancreatic protocol) when we have any concerns related to pancreatic cancer, like weight loss, family history of pancreatic cancer, jaundice or any abnormalities on the ultrasound abdomen.

Thank you.