B87 Splenomegaly (ICD-10:R16.1)

Introduction

Splenomegaly refers to the enlargement of the spleen, an organ located in the upper left side of the abdomen beneath the ribs^[1]. The spleen normally measures approximately 12 cm in length, and splenomegaly is diagnosed when the spleen extends more than 2 cm below the left costal margin during physical examination^[2]. This condition can be a manifestation of various underlying diseases and may cause significant symptoms and complications^[3]. This comprehensive guide provides an evidence-based overview of the symptoms, causes, diagnostic approaches, and treatment options for splenomegaly.

Codes

• ICPC-2 Code: B87 Splenomegaly
• ICD-10 Code: R16.1 Splenomegaly, not elsewhere classified^[4]

Symptoms

The clinical presentation of splenomegaly varies depending on the size of the enlarged spleen and underlying cause^[2]:

Primary Symptoms

• Abdominal pain or discomfort: Pain or fullness in the upper left quadrant of the abdomen, often the most common symptom^[2]
• Early satiety and feeling of fullness: Enlarged spleen compresses the stomach, leading to decreased appetite and feeling full after eating small amounts^[2]
• Left shoulder pain: Referred pain due to irritation of the diaphragm^[2]
• Abdominal bloating and distention: Noticeable enlargement of the abdomen^[2]

Systemic Symptoms

• Fatigue and weakness: Often related to underlying conditions causing splenomegaly or associated cytopenias^[2]
• Easy bruising or bleeding: Due to thrombocytopenia (low platelet count) from splenic sequestration^[3]
• Frequent infections: Increased susceptibility due to neutropenia or compromised immune function^[2]
• Constitutional symptoms: Including weight loss, night sweats, and fever, particularly when associated with malignancy^[2]

Causes

Splenomegaly has numerous potential causes, which can be categorized as follows^[2]:

Liver Disease

• Cirrhosis and hepatitis: Portal hypertension from liver disease is one of the most common causes of splenomegaly^[3]
• Portal vein thrombosis: Leads to increased vascular pressure and splenic enlargement^[2]

Hematologic Malignancies

• Lymphomas: Both Hodgkin and non-Hodgkin lymphoma can cause significant splenomegaly^[2]
• Leukemias: Chronic lymphocytic leukemia and chronic myeloid leukemia commonly present with enlarged spleen^[3]
• Myeloproliferative disorders: Including myelofibrosis, polycythemia vera, and essential thrombocythemia^[5]

Infections

• Viral infections: Infectious mononucleosis (Epstein-Barr virus), cytomegalovirus, and viral hepatitis^[2]
• Bacterial infections: Including endocarditis, tuberculosis, and splenic abscess^[2]
• Parasitic infections: Malaria is a leading cause globally, along with visceral leishmaniasis^[3]

Autoimmune and Inflammatory Conditions

• Rheumatoid arthritis: Splenomegaly combined with neutropenia is known as Felty syndrome^[2]
• Systemic lupus erythematosus: Frequently associated with splenomegaly^[3]
• Sarcoidosis: Can cause splenic involvement in up to 24% of cases^[2]

Other Causes

• Congestive heart failure: Can lead to splenic congestion and enlargement^[2]
• Infiltrative disorders: Including amyloidosis and glycogen storage diseases^[2]
• Hemolytic anemias: Including sickle cell disease and thalassemias^[3]

Diagnostic Steps

Medical History

Comprehensive history taking should include^[2]:

• Symptom assessment: Duration and severity of abdominal pain, fatigue, and associated symptoms
• Past medical history: Previous diagnoses of liver disease, blood disorders, infections, or autoimmune conditions
• Family history: Genetic blood disorders or malignancies
• Travel history: Exposure to endemic infections such as malaria
• Medication history: Drugs that may cause splenomegaly or cytopenias
• Social history: Alcohol use, injection drug use, and occupational exposures

Physical Examination

Physical examination techniques include^[2]:

• Spleen palpation: Performed with patient in supine and right lateral decubitus position; abnormal if palpable more than 2 cm below the left costal margin
• Liver examination: Assessment for hepatomegaly and signs of liver disease
• Lymph node assessment: Evaluation for generalized lymphadenopathy
• Skin examination: Looking for petechiae, purpura, jaundice, or rashes
• General appearance: Assessment for pallor, weight loss, and overall clinical condition

Laboratory Tests

Initial Laboratory Studies

• Complete blood count (CBC) with differential: Essential to identify cytopenias, which occur in up to 75% of patients with splenomegaly^[2]
• Comprehensive metabolic panel: Including liver function tests to assess for hepatic causes
• Peripheral blood smear: Microscopic examination to identify abnormal blood cells or parasites
• Lactate dehydrogenase (LDH): Often elevated in hematologic malignancies

Specialized Testing Based on Clinical Suspicion

• Infectious disease testing: Including viral hepatitis panel, Epstein-Barr virus, cytomegalovirus, HIV testing
• Autoimmune markers: Antinuclear antibodies, rheumatoid factor, complement levels
• Hematologic studies: Flow cytometry, bone marrow biopsy when malignancy suspected
• Genetic testing: For hereditary conditions such as Gaucher disease or hereditary spherocytosis

Diagnostic Imaging

First-Line Imaging

• Abdominal ultrasonography: Non-invasive, cost-effective method to confirm splenomegaly and assess splenic size^[6]
• Accuracy: High sensitivity and specificity compared to physical examination alone

Advanced Imaging

• CT scan: Provides detailed assessment of spleen size, structure, and surrounding organs; useful for identifying focal lesions^[2]
• MRI: Superior soft tissue contrast, particularly useful for evaluating splenic masses or infiltrative processes
• Nuclear medicine studies: Technetium-99m sulfur colloid scan can assess splenic function and identify accessory spleens

Additional Diagnostic Procedures

• Bone marrow biopsy: Indicated when hematologic malignancy is suspected based on clinical findings and laboratory results
• Splenic biopsy: Rarely performed due to bleeding risk; reserved for specific diagnostic dilemmas
• Genetic testing: For inherited conditions when family history or clinical features suggest hereditary causes

Possible Interventions

Traditional Medical Interventions

Targeted Medications Based on Underlying Cause

1. JAK2 Inhibitors (for Myeloproliferative Disorders)

• Ruxolitinib (Jakafi): FDA-approved for myelofibrosis with significant splenomegaly
• Cost: $15,000-20,000 per month^[5]
• Efficacy: Achieves ≥35% spleen volume reduction in 28-42% of patients
• Side effects: Thrombocytopenia, anemia, increased infection risk
• Monitoring: Regular blood counts and liver function tests

2. Hydroxyurea (for Myeloproliferative Disorders)

• Mechanism: Cytoreductive agent that can reduce spleen size
• Cost: $50-200 per month for generic formulations^[7]
• Efficacy: Reduces spleen size by 50% in approximately 40% of patients^[5]
• Side effects: Skin hyperpigmentation, oral ulcers, increased skin cancer risk

3. Antimicrobial Therapy (for Infectious Causes)

• Antibiotics: For bacterial infections causing splenomegaly
• Antiviral medications: Specific therapy for viral hepatitis
• Antimalarial drugs: For malaria-associated splenomegaly
• Cost: $10-500 per month depending on specific agent and duration

4. Corticosteroids (for Autoimmune Causes)

• Prednisone: For inflammatory and autoimmune conditions
• Cost: $10-50 per month for generic formulations
• Side effects: Long-term use associated with osteoporosis, diabetes, increased infection risk
• Monitoring: Regular assessment for steroid-related complications

5. Immunomodulatory Agents

• Rituximab: For lymphomas and certain autoimmune conditions
• Methotrexate: For rheumatoid arthritis and Felty syndrome
• Cost: Varies widely from $100-5,000 per month depending on agent

Surgical Interventions

Splenectomy (Complete Spleen Removal)

• Indications: Massive splenomegaly causing symptoms, severe cytopenias, or diagnostic uncertainty^[8]
• Approaches:
  • Laparoscopic splenectomy (preferred when feasible)
  • Open splenectomy for massive spleens or technical considerations
• Cost: $11,900-24,119 for laparoscopic approach in the United States^[9]
• Complications: Post-splenectomy infections, thrombocytosis, increased risk of encapsulated bacterial infections
• Long-term considerations: Requires lifelong vaccination protocols and antibiotic prophylaxis

Partial Splenic Embolization (PSE)

• Procedure: Interventional radiology technique that blocks blood supply to portion of spleen^[8]
• Indications: Alternative to splenectomy in high-surgical-risk patients
• Cost: $9,000-16,000 based on international studies^[10]
• Efficacy: Can achieve significant spleen size reduction and symptom improvement
• Complications: Post-embolization syndrome (fever, pain), splenic abscess (rare), re-embolization may be needed

Splenic Radiation Therapy

• Technique: Low-dose external beam radiation to reduce spleen size
• Indications: Palliative treatment for massive splenomegaly when surgery contraindicated
• Efficacy: Temporary reduction in spleen size and symptoms
• Side effects: Radiation-induced cytopenias, gastrointestinal symptoms

Alternative and Complementary Interventions

Traditional Chinese Medicine

• Acupuncture: May help with symptom management including pain and fatigue^[11]
• Cost: $60-120 per session
• Evidence: Limited clinical studies; may provide supportive care benefits
• Chinese herbal medicine: Specific formulations traditionally used for spleen disorders

Mind-Body Therapies

• Meditation and mindfulness: Stress reduction techniques that may improve quality of life
• Yoga: Gentle forms may help with flexibility and stress management
• Cost: $15-30 per class or free with online resources
• Precautions: Avoid poses that put pressure on the abdomen

Nutritional Interventions

• Anti-inflammatory supplements: Turmeric, omega-3 fatty acids may have supportive benefits
• Cost: $20-100 per month depending on specific supplements
• Evidence: Limited scientific support; should complement, not replace medical treatment

Lifestyle Interventions

Dietary Modifications

Foods to Emphasize:

• Anti-inflammatory foods: Fatty fish, leafy greens, berries, and whole grains^[12]
• Warm, cooked foods: Traditional Chinese medicine principles suggest easier digestion
• Adequate protein: To support immune function and blood cell production

Foods to Avoid:

• Fried and processed foods: May increase inflammation and burden digestive system^[12]
• Excessive red meat: Difficult to digest and may increase metabolic burden
• Refined sugars: Can contribute to inflammation
• Alcohol: Particularly important to avoid if liver disease is underlying cause

Physical Activity Considerations

• Gentle exercise: Walking, swimming, or light resistance training as tolerated
• Contact sport restrictions: Patients with splenomegaly should avoid contact sports due to rupture risk^[2]
• Activity modification: Based on degree of enlargement and underlying condition

General Health Measures

• Adequate sleep: 7-8 hours nightly to support immune function and recovery^[12]
• Stress management: Chronic stress can worsen inflammatory conditions
• Infection prevention: Proper hygiene, avoiding sick contacts, up-to-date vaccinations
• Regular monitoring: Adherence to follow-up appointments and laboratory monitoring

Follow-up and Patient Education

Monitoring Schedule

• Initial phase: Close monitoring every 4-6 weeks until underlying cause identified and treatment initiated
• Stable patients: Every 3-6 months with physical examination and relevant laboratory studies
• Imaging follow-up: Periodic assessment of spleen size based on underlying condition and treatment response

Patient Education Priorities

• Recognition of complications: Signs requiring immediate medical attention (severe abdominal pain, trauma, signs of infection)
• Activity restrictions: Importance of avoiding contact sports and activities with high trauma risk
• Medication compliance: Adherence to prescribed treatments and monitoring requirements
• Lifestyle modifications: Dietary recommendations and infection prevention strategies
• Long-term outlook: Prognosis varies significantly based on underlying cause

Mirari Cold Plasma Alternative Intervention

Understanding Mirari Cold Plasma

• Safe and Non-Invasive Treatment: Mirari Cold Plasma is a safe and non-invasive treatment option for various skin conditions. It does not require incisions, minimizing the risk of scarring, bleeding, or tissue damage.
• Efficient Extraction of Foreign Bodies: Mirari Cold Plasma facilitates the removal of foreign bodies from the skin by degrading and dissociating organic matter, allowing easier access and extraction.
• Pain Reduction and Comfort: Mirari Cold Plasma has a local analgesic effect, providing pain relief during the treatment, making it more comfortable for the patient.
• Reduced Risk of Infection: Mirari Cold Plasma has antimicrobial properties, effectively killing bacteria and reducing the risk of infection.
• Accelerated Healing and Minimal Scarring: Mirari Cold Plasma stimulates wound healing and tissue regeneration, reducing healing time and minimizing the formation of scars.

Mirari Cold Plasma Prescription

Video instructions for using Mirari Cold Plasma Device – B87 Splenomegaly (ICD-10:R16.1)

Mild	Moderate	Severe
Mode setting: 1 (Infection) Location: 3 (Kidney, Liver & Spleen) Morning: 15 minutes, Evening: 15 minutes	Mode setting: 1 (Infection) Location: 3 (Kidney, Liver & Spleen) Morning: 30 minutes, Lunch: 30 minutes, Evening: 30 minutes	Mode setting: 1 (Infection) Location: 3 (Kidney, Liver & Spleen) Morning: 30 minutes, Lunch: 30 minutes, Evening: 30 minutes
Mode setting: 2 (Wound Healing) Location: 3 (Kidney, Liver & Spleen) Morning: 15 minutes, Evening: 15 minutes	Mode setting: 2 (Wound Healing) Location: 3 (Kidney, Liver & Spleen) Morning: 30 minutes, Lunch: 30 minutes, Evening: 30 minutes	Mode setting: 2 (Wound Healing) Location: 3 (Kidney, Liver & Spleen) Morning: 30 minutes, Lunch: 30 minutes, Evening: 30 minutes
Mode setting: 7 (Immunotherapy) Location: 1 (Sacrum) Morning: 15 minutes, Evening: 15 minutes	Mode setting: 7 (Immunotherapy) Location: 1 (Sacrum) Morning: 30 minutes, Lunch: 30 minutes, Evening: 30 minutes	Mode setting: 7 (Immunotherapy) Location: 1 (Sacrum) Morning: 30 minutes, Lunch: 30 minutes, Evening: 30 minutes
Total Morning: 45 minutes approx. $7.50 USD, Evening: 45 minutes approx. $7.50 USD	Total Morning: 90 minutes approx. $15 USD, Lunch: 90 minutes approx. $15 USD, Evening: 90 minutes approx. $15 USD	Total Morning: 90 minutes approx. $15 USD, Lunch: 90 minutes approx. $15 USD, Evening: 90 minutes approx. $15 USD
Usual treatment for 7-60 days approx. $105 USD – $900 USD	Usual treatment for 6-8 weeks approx. $1,890 USD – $2,520 USD	Usual treatment for 3-6 months approx. $4,050 USD – $8,100 USD

Localized (0) Sacrum (1) Prostate & Uterus (2) Kidney, Liver & Spleen (3) Heart, Bile & Pancreas (4) Lungs (5) Throat, Lymphatic & Thyroid (6) Neuro system & ENT (7)

Use the Mirari Cold Plasma device to treat Splenomegaly effectively.

WARNING: MIRARI COLD PLASMA IS DESIGNED FOR THE HUMAN BODY WITHOUT ANY ARTIFICIAL OR THIRD PARTY PRODUCTS. USE OF OTHER PRODUCTS IN COMBINATION WITH MIRARI COLD PLASMA MAY CAUSE UNPREDICTABLE EFFECTS, HARM OR INJURY. PLEASE CONSULT A MEDICAL PROFESSIONAL BEFORE COMBINING ANY OTHER PRODUCTS WITH USE OF MIRARI.

Step 1: Cleanse the Skin

• Start by cleaning the affected area of the skin with a gentle cleanser or mild soap and water. Gently pat the area dry with a clean towel.

Step 2: Prepare the Mirari Cold Plasma device

• Ensure that the Mirari Cold Plasma device is fully charged or has fresh batteries as per the manufacturer’s instructions. Make sure the device is clean and in good working condition.
• Switch on the Mirari device using the power button or by following the specific instructions provided with the device.
• Some Mirari devices may have adjustable settings for intensity or treatment duration. Follow the manufacturer’s instructions to select the appropriate settings based on your needs and the recommended guidelines.

Step 3: Apply the Device

• Place the Mirari device in direct contact with the affected area of the skin. Gently glide or hold the device over the skin surface, ensuring even coverage of the area experiencing.
• Slowly move the Mirari device in a circular motion or follow a specific pattern as indicated in the user manual. This helps ensure thorough treatment coverage.

Step 4: Monitor and Assess:

• Keep track of your progress and evaluate the effectiveness of the Mirari device in managing your Splenomegaly. If you have any concerns or notice any adverse reactions, consult with your health care professional.

Note

This guide is for informational purposes only and should not replace the advice of a medical professional. Always consult with your healthcare provider or a qualified medical professional for personal advice, diagnosis, or treatment. Do not solely rely on the information presented here for decisions about your health. Use of this information is at your own risk. The authors of this guide, nor any associated entities or platforms, are not responsible for any potential adverse effects or outcomes based on the content.

Mirari Cold Plasma System Disclaimer

• Purpose: The Mirari Cold Plasma System is a Class 2 medical device designed for use by trained healthcare professionals. It has received clearance from the U.S. FDA and is registered for use in Thailand and Vietnam. It is not intended for use outside of these locations.
• Informational Use: The content and information provided with the device are for educational and informational purposes only. They are not a substitute for professional medical advice or care.
• Variable Outcomes: While the device is approved for specific uses, individual outcomes can differ. We do not assert or guarantee specific medical outcomes.
• Consultation: Prior to utilizing the device or making decisions based on its content, it is essential to consult with a Certified Mirari Tele-Therapist and your medical healthcare provider regarding specific protocols.
• Liability: By using this device, users are acknowledging and accepting all potential risks. Neither the manufacturer nor the distributor will be held accountable for any adverse reactions, injuries, or damages stemming from its use.
• Geographical Availability: This device has received approval for designated purposes by the Thai and Vietnam FDA. As of now, outside of Thailand and Vietnam, the Mirari Cold Plasma System is not available for purchase or use.

References

1. Gesund.bund.de. ICD-10 code: R16.1 Splenomegaly, not elsewhere classified. 2024. Available from: https://gesund.bund.de/en/icd-code-search/r16-1
2. Patel D, Desai S, Gross SA. Splenomegaly. StatPearls. 2023. Available from: https://www.ncbi.nlm.nih.gov/books/NBK430907/
3. World Health Organization. International Classification of Diseases, 10th Revision (ICD-10). Geneva: WHO Press; 2019. Available from: https://icd.who.int/browse10/2019/en
4. American Academy of Professional Coders. ICD-10 code R16.1 for Splenomegaly, not elsewhere classified. 2023. Available from: https://www.aapc.com/codes/icd-10-codes/R16.1
5. Rare Disease Advisor. Managing Massive Splenomegaly Associated With Primary Myelofibrosis. 2024. Available from: https://www.rarediseaseadvisor.com/insights/managing-massive-splenomegaly-primary-myelofibrosis/
6. Rajesh S, et al. Modern Management of Splenomegaly in Patients with Myelofibrosis. PMC. 2020. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC7809704/
7. GoodRx. Hydroxyurea Prices and Coupons. 2024. Available from: https://www.goodrx.com/hydroxyurea
8. Rajesh S, et al. Modern Management of Splenomegaly in Patients with Myelofibrosis. PMC. 2020. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC7809704/
9. MDsave. How Much Does a Spleen Removal (Splenectomy) – Laparoscopic Cost? 2025. Available from: https://www.mdsave.com/procedures/spleen-removal-splenectomy-laparoscopic/d583fdcd
10. Tingey BE, et al. The cost to perform splenic artery embolisation following blunt trauma. ANZ Journal of Surgery. 2021. Available from: https://pubmed.ncbi.nlm.nih.gov/32962832/
11. My Art of Wellness. How to Treat Splenomegaly (Enlarged Spleen) With Acupuncture and TCM. 2024. Available from: https://myartofwellness.com/how-to-treat-splenomegaly-enlarged-spleen-with-acupuncture-and-tcm/
12. Dr. Karuna Kumar. Foods to Avoid with Enlarged Spleen. 2025. Available from: https://www.drkarunhematology.com/blog/foods-to-avoid-with-enlarged-spleen/