splenomegaly in children
Introduction
Introduction to pediatric splenomega Spleen enlargement is a common sign in infants and children. It is commonly seen in systemic diseases such as infections, blood diseases, metabolic diseases, tumors, etc. Diseases limited to the spleen itself are rare. In acute infections, the spleen is often seen within a few days. Congestion can be reached under the left costal margin; the splenomegaly caused by chronic infection is mainly due to hyperplastic infiltration. It should be noted that in most premature infants and 30% of full-term infants, the spleen can be touched immediately after birth, 5~ Only 65% of normal babies in 6 months can be reached, and generally cannot be touched thereafter. Only a few occasional sensations can be reached by the age of 3 to 4. basic knowledge The proportion of illness: 0.002% Susceptible people: children Mode of infection: non-infectious Complications: hypersplenism hemolytic anemia
Cause
Pediatric splenomegaly
(1) Causes of the disease
In order to find the cause of spleen enlargement, we must first analyze from the medical history whether there are infectious factors such as microorganisms and parasites, whether there are congenital hemolytic diseases or metabolic diseases, whether there are other blood diseases, tumor diseases, and, in addition, splenomegaly often Epidemics (such as malaria) and ethnic genetic diseases (such as Guangdong, Guangxi, and other common thalassemia), should also pay attention to trace, physical examination to pay attention to other signs, combined with medical history can sometimes be diagnosed, severe splenomegaly Found in parasitic diseases, bacterial or viral infections, malnutrition combined with infection caused by anemia, congenital metabolic disease, Banti syndrome, etc., liver and splenomegaly appear more often in neonatal and infant infections, nutritional anemia, Malnutrition combined with infection caused by anemia, hemolytic anemia, congenital metabolic disease, leukemia, malignant lymphoma, Langhans cell histiocytosis, amyloidosis, etc., if necessary, special laboratory tests, such as blood, bone marrow, Blood culture, skin test, anti-human globulin test, antibody test and examination of urine, stool and parasites, ultrasound can also be used Waves, X-rays, isotope, CT scans and other techniques to make a diagnosis.
(two) pathogenesis
The pathological changes of splenomegaly are currently considered to be diverse and are briefly described below.
1. After fetal hematopoiesis, the spleen mainly produces lymphocytes (35% to 50% are T lymphocytes, 50% to 65% are B lymphocytes), but in emergencies such as hemorrhage, hemolysis, infant anemia or immature leukocyte infiltration At the time, the spleen may be swollen by restoring the hematopoietic function of the fetus.
2. Congestive splenomegaly There are a large number of venous sinus in the spleen, which has the characteristics of contraction and swelling. When the spleen venous reflux occurs, such as portal hypertension, the spleen can be hyperemia, children with polycythemia vera or thrombocytopenia. At the same time, splenomegaly may also be caused by excessive storage of blood cells.
3. Excessive spleen function When the spleen function is too strong, one or more blood cells in the blood may be destroyed excessively, causing anemia, bleeding or the ability to resist infection, and this phenomenon may occur when the portal pressure is increased.
4. Immune factors The spleen is an organ that produces antibodies and is directly related to immune function. Infection and antigenic stimulation can proliferate lymphoid tissues, produce more plasma cells, lymphocytes and macrophages and cause spleen enlargement.
Prevention
Pediatric splenomega prevention
It is best to pay attention to living habits, pay attention to daily life behavior, and find early treatment early.
Complication
Pediatric splenomegaly complications Complications, hypersplenism, hemolytic anemia
When the spleen function is hyperthyroidism, it can be caused by hemolytic anemia, neutropenia, and other complications depending on the primary disease.
Symptom
Symptoms of splenomegaly in children, common symptoms, hypersplenism, repeated infection, histiocytosis, liver disease, portal hypertension, sepsis, heart failure
Under normal circumstances, the spleen should not be affected; in the supine position, the lateral iliac crest and the spleen indicate that the volume is more than 1 times normal, the abdominal wall of the child is thin, and it is easy to squat in the supine position. 1 to 2 cm below the edge, after 1 year of age, the spleen should not be affected under the costal margin. When the palpation method cannot determine the size of the spleen, the spleen can be used to check whether the spleen is enlarged or not. The normal spleen is in the left.911 ribs, thickness 47cm, no more than anterior anterior line, left hepatic lobe enlargement, left retroperitoneal mass, pancreatic cyst, colon spleen, tuberculous peritonitis with omental mass, often easy The spleen is confused and should be identified.
Infectious disease
(1) Acute infectious diseases:
1 virus infection:
A. Rubella: The spleen can be swollen, but mostly mild.
B. Children's acute rash: clinical manifestations of fever, rash, occipital lymphadenopathy, spleen can be mildly swollen, hot rash, rash is a reddish rash.
C. Infectious mononucleosis: caused by Epstein-Barr virus, showing fever, angina, lymph node and spleen enlargement, total peripheral blood lymphocytes increased, and more than 10% are atypical lymphocytes.
D. systemic giant cell inclusion disease: caused by infection of giant cell inclusion body virus, may be congenital or acquired infection, congenital symptoms are obvious, clinical often have jaundice, purpura, liver and spleen Swelling, often accompanied by signs of nervous system symptoms such as lethargy, convulsions, hydrocephalus, and microcephaly.
E. Viral hepatitis: There are jaundice, liver function damage, moderate liver enlargement, and mild swelling of the spleen.
2 bacterial infections:
A. sepsis: often splenomegaly, mostly mild swelling, soft.
B. Typhoid fever, paratyphoid fever: clinically have fever, mild splenomegaly, decreased white blood cell count, and relatively increased lymphocyte counts.
C. Infective endocarditis: often splenomegaly, mild, soft, mild tenderness, severe pain if infarction occurs, when the original heart valve disease occurs Unexplained fever for more than 1 week, with anemia, skin defects, heart murmur changes should consider the possibility of infective endocarditis, echocardiography found that neoplasms can be diagnosed.
D. spleen abscess: rare, domestic cases are rarely reported, often secondary to splenic vein thrombosis, sepsis and abdominal cavity and other purulent infections, there are cases of unclear primary lesions, clinical manifestations of sepsis, peripheral blood leukocyte count increased And the left side of the nucleus, check the splenomegaly, the spleen palpation has a certain area of tenderness and fluctuations, the spleen area pain radiates to the left shoulder, cough can make the pain worse, if the disease is accompanied by inflammation around the spleen, the spleen area can be heard And friction sound, touch the sense of friction, spleen ultrasound is helpful for diagnosis, spleen puncture and pus can confirm the diagnosis.
E. Acute miliary tuberculosis: more common in children with low immunity, persistent high fever, severe symptoms of poisoning, often liver, spleen, swollen lymph nodes.
3 rickettsial infection, typhus and tsutsugamushi: can have mild swelling of the spleen.
4 spirochete infection: leptospirosis, rat bite heat, and return to heat.
5 parasitic infections: malaria, kala-azar, toxoplasmosis, schistosomiasis, echinococcosis.
A. Malaria: Splenomegaly is a common sign of the disease.
B. Black fever: The lesion mainly involves the mononuclear-macrophage system, which has obvious splenomegaly, often irregular fever, anemia, weight loss, and bone marrow puncture can be diagnosed by kala-azar.
(2) Chronic infectious splenomegaly:
1 Chronic viral hepatitis: more splenomegaly than acute, mostly mild swelling, hard, no tenderness, and more acute viral liver disease history.
2 chronic schistosomiasis: fever, gastrointestinal symptoms, hepatosplenomegaly.
3 chronic malaria (chronic malaria): the spleen can be extremely swollen, hard, the peripheral blood is not easy to see the malaria parasite, the adrenaline firing test is often negative, according to the history of past malaria parasites and epidemiological history, bone marrow to see the malaria parasite helps diagnosis.
4 sarcosis (sarcoidosis): the cause is unknown, rare, can affect the body system, 50% to 60% involving the liver and spleen, so there are liver, spleen, lymph nodes.
5 histoplasmosis (histoplasmosis): caused by capsular histoplasma, invading bone marrow, lung, liver, spleen, lymph nodes, deep mycosis, more common in 6 to 24 months of sick children, clinical manifestations Variety, often liver, spleen, lymph node enlargement, tissue cytoplasmic skin test positive, bone marrow smear found macrophage capsular histoplasmosis spores, blood, bone marrow, lymph node pus and sputum, etc. Fungal culture can help diagnose.
6 toxoplasmosis (toxoplasmosis): a systemic infectious disease caused by Toxoplasma protozoa, subacute, the disease is divided into acute congenital toxoplasmosis and acquired acquired toxoplasmosis, congenital toxoplasmosis, At birth, there are severe jaundice, skin maculopapular rash, purpura and hepatosplenomegaly, accompanied by symptoms and signs of nervous system such as convulsions, chorioretinitis, asymptomatic early onset infection, convulsions and developmental infancy, hepatosplenomegaly Big.
7 congenital syphilis: may have mild splenomegaly, most cases can be asymptomatic.
8 brucellosis (brucellosis): caused by Brucella, is a zoonotic disease, often by eating sick cow milk, meat or close contact with diseased cattle and sheep, clinically often cyclical, Waves repeatedly fever, if not treated for several months, there may be chills, sweating, joint neuralgia, lymph nodes and hepatosplenomegaly, 70% to 80% of cases of bone marrow examination can obtain pathogenic bacteria, Brinell The bacillus skin test and serum agglutination test can be positive, and streptomycin and sulfonamide have a good therapeutic effect on the disease.
2. Non-infectious splenomegaly
(1) Congestive splenomegaly:
1 portal hypertension (portal hypertension): portal hypertension can cause congestive splenomegaly, when the cause of congestion is removed, the enlarged spleen can be retracted, and advanced cases due to fibrous tissue and reticuloendothelial hyperplasia, even if the cause is removed There is no obvious retraction of splenomegaly. The main cause of portal hypertension in children is portal vein and splenic vein embolism. Splenic vein embolism may be associated with neonatal umbilical inflammation, neonatal sepsis, umbilical vein intubation complications, portal vein spongy Tumor, congenital spleen vascular malformation, abdominal mass compression, etc., portal hypertension can be divided into two types of intrahepatic and extrahepatic, the common features of two types of portal hypertension are hematemesis (upper gastrointestinal bleeding), splenomegaly and ascites Splenomegaly may be associated with anemia, peripheral blood whole blood cell reduction, skin mucosal bleeding, bone marrow hyperplasia and other spleen hyperfunction.
A. Extrahepatic portal hypertension: The disease has upper gastrointestinal symptoms (hematemesis and melena) earlier; ascites is less common and easy to resolve; spleen is significantly enlarged with hypersplenism, may have neonatal sepsis, umbilical History, or history of umbilical vein intubation, without a history of hepatitis.
B. Intrahepatic portal hypertension: common in chronic hepatitis cirrhosis, post-necrosis cirrhosis, advanced schistosomiasis cirrhosis, congenital biliary stricture, etc., hematemesis, blood in the stool, and other gastrointestinal symptoms appear later than the liver The disease occurs between 2 and 12 years old. Gastrointestinal hemorrhage is often accompanied by malnutrition, mostly refractory ascites, abnormal liver function with coagulopathy, liver enlargement or shrinkage, hard texture and nodules. Significant splenomegaly is often accompanied by hypersplenism. Portal venography is the main method for diagnosing this disease. In cases of difficult diagnosis, the diagnosis should be confirmed by laparotomy.
2 chronic congestive heart failure (chronic congestive heart failure): more common in school-age children, long-term venous congestion caused by cardiogenic cirrhosis can lead to splenomegaly, but less common.
3 constrictive pericarditis (constrictive pericarditis): for cardiogenic chronic obstructive congestion, 85% have splenomegaly, mostly mild.
4 portal vein thrombosis (portal thrombosis): very rare, can be divided into acute and chronic, both have splenomegaly, acute type often secondary to splenectomy, portal vein surgery, portal vein infection or trauma, its main clinical manifestations For acute abdominal pain, bloating, vomiting, hematemesis and blood in the stool, chronic portal vein thrombosis is more common than acute, common in cirrhosis, followed by liver cancer or other organs in the abdominal cavity, eroding the portal vein, children may have ascites, splenomegaly and Hypersplenism, the liver is rarely swollen, the spleen enlargement is obvious, this point can be distinguished from hepatic vein obstruction, splenic portal vein angiography is the main method for the diagnosis of this disease, some patients can be diagnosed by surgical exploration.
5 Budd-Chiari syndrome: clinically rare, only a few cases reported in China, many caused by thrombosis, the original hair is rare, mostly secondary, acute and chronic, acute manifestations For abdominal pain, mild jaundice, liver, ascites, chronic type in addition to abdominal pain, liver and dyspepsia, there are still splenomegaly, ascites, inferior vena cava angiography to determine the diagnosis, the disease has a poor prognosis.
(2) blood diseases: a variety of blood cases can have splenomegaly, and often accompanied by different degrees of swelling of the liver and lymph nodes.
1 hemolytic disease of newborn: jaundice within 24 hours after birth, splenomegaly, anemia, often caused by maternal and child ABO, Rh blood group incompatibility.
2 hemolytic anemia (hemolytic anemia): for example, hereditary spherocytosis, thalassemia, autoimmune hemolytic anemia, etc., often family history, splenomegaly, hard texture, jaundice, liver enlargement .
3 idiopathic thrombocytopenic purpura (idiopathic thrombocytopenic purpura): acute spleen is not large, chronic type often has mild splenomegaly.
4 iron-deficiency anemia (iron-deficiency anemia): often mild to moderate hepatosplenomegaly.
5 leukemia (leukemia): leukemia often accompanied by splenomegaly, the obvious enlargement of lymphocytic leukemia, followed by granulocyte type, monocytic leukemia mostly mild splenomegaly, acute and chronic leukemia, especially Chronic myeloid leukemia is severely spleen, and acute lymphoblastic leukemia is more obvious than acute myeloid leukemia.
Several rare leukemias such as erythroleukemia, hairy cell leukemia, tissue basophilic leukemia, eosinophilic leukemia, basophilic leukemia, plasma cell leukemia, lymphosarcoma leukemia, megakaryocytic leukemia, etc. have varying degrees of splenomegaly However, they are extremely rare, so select a few of them as follows.
A. Erythroleukemia (erythroleukemia): an acute or chronic proliferative disease of erythrocytic tissue, which can eventually be converted into acute myeloid leukemia. Clinical features include progressive anemia with fever, hemorrhage, hepatosplenomegaly, peripheral blood. There are various stages of immature red blood cells and immature granulocytes, mainly primary red and early red blood cells, and there are abnormal morphological, nucleoplasmic development imbalance, often with multi-leaf nucleus, young red blood cells are giant and young, and mature red blood cells vary in size. If the staining is too deep or normal, the platelets can also be deformed. The bone marrow shows that the red blood cell system and the granulocyte system proliferate at the same time, but the red blood cell system proliferates obviously. The nucleated red blood cells are mainly young red, young red is young, and the red blood cells are >50%. The nucleated red blood cells are megaloblastic and malformed, with mature stagnation and ring iron granules (such as nucleus red giant larvae and malformations are not obvious, the ratio of granule red is 1:1 or even inverted) has diagnostic value. The immature granulocytes of the granulocyte system are obviously proliferating, with the dominant granulocytes and promyelocytes predominating >30%, and the histochemical examination shows that the erythrocyte PAS staining is mostly positive. Neutrophil alkaline phosphatase is often reduced, which is conducive to the diagnosis of this disease. The anemia of this disease is not effective for iron, vitamin B12 and corticosteroid treatment.
B. Hairy cell leukemia: a lymphatic reticulum malignant proliferative disease, reported in foreign countries accounted for 2% to 3% of the incidence of leukemia, reported in recent years in the country, the disease is more common in men, men and women The ratio is 6:1. Most cases are insidious. The main clinical manifestations are anemia, fatigue, weight loss, fever, bleeding in the skin and mucous membranes, rib discomfort in the left season, signs of significant swelling of the spleen, and often no swelling of the lymph nodes. Or only mild swelling, laboratory examination of peripheral blood red blood cell count, white blood cell count, platelet count decreased, positive cell positive pigment anemia performance, peripheral blood smear showed abnormal mononuclear cells and characteristic hair cells, typical hair The cells have irregular slender protrusions, such as hair, which are named after them. The ribosome lamellar complex or vacuole can be observed in the cytoplasm of the cell, and the tissue-stained hair cell peroxidase, Sudan black, alkali The phosphatase was negative in some cases. In some cases, the hair cell glycogen staining was positive, acid phosphatase was positive and not inhibited by L-tartaric acid (lymphocytes, plasma cells and macrophages can be L-tartaric acid inhibition), typical cases of bone marrow smear examination of characteristic hair cells can account for 50% to 80% of the cell classification count, but bone marrow puncture is often dry, bone marrow biopsy can be seen a lot of hair cell infiltration, spleen, liver, lymph node pathology Examination of visible hair cell infiltration to form tumor nodules lesions, diagnosis based mainly on clinical symptoms, signs and peripheral blood, bone marrow or other organs to find hair cells, the disease is chronic, the prognosis is poor, there is no effective therapy, single or Combined chemotherapy, spleen X-ray irradiation effect is not obvious, prednisone treatment has a certain effect, but can not be maintained, accompanied by splenic hyperthyroidism after splenectomy can significantly relieve the condition.
C. Megakaryocytic leukemia: It can be divided into acute and chronic type, chronic type is more common, clinical features include progressive anemia, significant hepatosplenomegaly, lymph node enlargement may not be obvious, often thrombosis and hemorrhage Tendency, peripheral blood red blood cells decreased, visible immature red blood cells, increased platelets, up to millions, and abnormal platelets, even can find naive megakaryocytes, the total number of white blood cells can be increased, classified neutrophils increased, visible immature granulocytes, bleeding Time prolonged, bone marrow, liver, spleen, lymph node puncture smear pathological examination showed megakaryocytes significantly hyperplasia, can be diagnosed, the disease is mainly found as atypical megakaryocytes, prototypical megakaryocytes are common, small cell bodies, nuclear non-filamentous division, There are all traces or two phases in the center, and the nucleolus is visible.
D. Tissue basophile cell leukemia: also known as mast cell leukemia, clinically very rare, a case report of the First Affiliated Hospital of West China University of Medical Sciences, the disease has the characteristics of leukemia, namely anemia, hemorrhage, fever, Skeletal pain, hepatosplenomegaly, pigmented urticaria in some cases, increased white blood cells in peripheral blood, tissue basophils may account for 10% to 81%, the cells are fusiform, long-tailed or irregular, filled with cytoplasm Dark blue basophilic particles with uniform circular shape, no peripheral blood cells (or only a small number of immature cells, platelets can be reduced, red blood cell count and hemoglobin are slightly reduced, bone marrow tissue basophils are obviously proliferated, accounting for 18% to 85%, The basophils are slightly increased, and the immature granulocytes are not increased. The diagnosis of this disease mainly depends on morphological and special histochemical changes. The basophils (mast cells) in the bone marrow are piled up or scattered, and the morphology is diverse. Contains basophilic particles, peroxidase and Sudan black B staining are negative, while glycogen staining is positive and not digested by amylase, can be distinguished from basophils, hepatosplenic lymph nodes Biopsy confirmed every organ and tissue infiltration of basophils may be diagnosis of the disease.
E. Plasma cell leukemia: Very rare in children, it is a plasma cell proliferative disease. The pathogenesis can be in two forms: one is leukemia in the early stage of the disease, and the other is multiple bone marrow. Tumor onset, later transformed into plasma cell leukemia, laboratory examination of peripheral blood leukocytes more than 10 × 109 / L, plasma cell count can account for more than 20%, red blood cells and thrombocytopenia, bone marrow hyperplasia is active or extremely active, abnormal plasma cells can account for 90%, about 50% of X-ray films showed bone changes, showing diffuse loose bone, osteolytic phenomenon or pathological fractures. The chemotherapy effect of this disease is poor, the prognosis is poor, and the average disease duration is 4-8 months.
F. Lymphosarcoma cell leukemia: Most occur in the end stage of lymphosarcoma and after radiation therapy, the incidence rate is 20%, of which 13% are mostly seen in children. The diagnosis point is lymph node painless progressive enlargement. Later, the clinical manifestations of acute leukemia, often accompanied by hepatosplenomegaly, a large number of primitive and immature lymphocytes in the peripheral blood and bone marrow, lymphoid sections or prints can be seen in a large number of lymphosarcoma cells, the cause is late lymphosarcoma, joint Chemotherapy can temporarily relieve the condition, easy to relapse, and the prognosis is extremely poor.
6 malignant lymphoma (malignant lymphoma): often accompanied by irregular periodic fever, lymphadenopathy and different degrees of liver and spleen enlargement, of which Hodgkin's disease granuloma type about 50% have splenomegaly, follicular lymph Tumors also often have splenomegaly. Hodgkin's disease occasionally has splenomegaly as a prominent sign, and the spleen can be extremely swollen without a superficial lymph node enlargement.
7 malignant histiocytosis: about 90% of cases have splenomegaly, and rapidly increase, but there are also a few patients with liver and spleen lymph nodes are not large.
8 familial eosinophilia: very rare, clinical manifestations of fever, hepatosplenomegaly, increased serum globulin, peripheral blood eosinophil count is often above 50 × 109 / L, bone marrow The number of eosinophils also increased.
9 idiopathic eosinophilia syndrome (idiopathic eosinophilia syndrome): autosomal dominant hereditary disease, the age of onset is 20 to 40 years old, children have also reported, early symptoms of cardiopulmonary insufficiency, giant heart Mostly caused by mitral regurgitation, fever, hepatosplenomegaly, eosinophilia in peripheral blood and bone marrow is its main clinical manifestation.
10 primary macroglobulinemia (primary macroglobulinemia): rare, is a lymphoplasmacytic disease, the cause is unknown, the elderly are more, more men than women, may have weight loss, fatigue, anemia, repeated infections, etc., liver Splenic lymphadenopathy, lymphoid tissue hyperplasia, especially plasma cell malignant hyperplasia, a large number of monoclonal IgM in serum, macroglobulinemia can make blood viscous, leading to heart failure, affecting the blood supply of major organs, the disease has a poor prognosis Death within a few months or a few years, the use of plasma separation can reduce blood viscosity, penicillamine can decompose macroglobulin, temporarily relieve symptoms, in recent years advocate the use of chlorambucil (tumorine) and cyclophosphamide treatment.
Examine
Pediatric splenomegaly
Blood routine
(1) bacterial infection: peripheral blood leukocyte count and neutrophil count increased, suggesting bacterial infection.
(2) Infectious mononucleosis: the total number of white blood cells is slightly increased or normal, lymphocyte counts increase, and more than 10% of atypical lymphocytes suggest infectious mononucleosis.
(3) Schistosomiasis and clonorchiasis: The classification of eosinophils and the increase in absolute counts of eosinophils are found in schistosomiasis and clonorchiasis.
(4) Leukemia: abnormally increased white blood cells and the appearance of primitive naive cells, suggesting leukemia.
(5) The total number of white blood cells is reduced: more considerations of typhoid fever, malaria, kala-azar, non-leukocytic leukemia, histoplasmosis.
(6) malignant histiocytosis, hypersplenism: peripheral blood two-phase or multi-phase blood cell reduction with splenomegaly, suggesting malignant histiocytosis, hypersplenism and so on.
(7) Malaria: Peripheral blood smears were found to see malaria parasites and malaria was diagnosed.
(8) Mucopolysaccharidosis: splenomegaly, peripheral blood or bone marrow neutrophils, see mucopolysaccharide particles are often mucopolysaccharidosis.
2. Hematological examination of hemolysis first determines whether there is hemolysis: reticulocytes, bone marrow examination, etc., and then determine the cause of hemolysis, generally Coombs test positive for congenital; Coombs test negative for congenital, then do erythrocyte membrane, red blood cells Enzyme, hemoglobin-related examination.
3. Urine examination urinary biliary positive, hemoglobinuria positive and Rous test positive for the diagnosis of hemolytic anemia, urinary bilirubin positive, urinary biliary positive, suggesting viral hepatitis caused by splenomegaly, urine viscosity Polysaccharide examination helps the diagnosis of mucopolysaccharidosis, and urine exfoliated cells can be found in the diagnosis of cytomegalovirus infection.
4. Examination of fecal eggs and edema can help the diagnosis of parasites such as liver flukes and schistosomiasis.
5. Bone marrow examination such as bone marrow smear found a large number of immature cells, abnormal tissue cells and lymphosarcoma cells contribute to the diagnosis of leukemia, malignant histiocytosis, malignant lymphoma, bone marrow smear to see Plasmodium and Lido body Can be diagnosed as malaria and kala-azar, bone marrow examination can be used to diagnose the diagnosis of primary thrombocytopenic purpura, multiple bone marrow puncture failure should consider bone marrow fibrosis, and should be further bone marrow biopsy.
6. Liver function tests to determine whether splenomegaly is associated with liver disease.
7. Etiology and immunology examination Blood, bone marrow, urine, feces culture contribute to sepsis, typhoid, infective endocarditis diagnosis, hypertrophy test, heterophilic agglutination test, kala-azar complement test, etc. Meaningful, patients with connective tissue disease can be measured by rheumatoid factor, lupus cells, antinuclear antibodies, and anti-DNA antibodies.
8. Puncture and biopsy
(1) lymph node puncture, biopsy, print: help lymphoma, malignant histiocytosis, metastatic lymphoma, immunoblastic lymphadenopathy, giant lymph node hyperplasia, immunodeficiency disease and subacute necrotizing lymphadenitis Diagnosis of the disease.
(2) Liver biopsy: help to identify chronic hepatitis, splenomegaly caused by portal cirrhosis, fatty liver, glycogen metabolism, hepatoblastoma, cirrhosis, mucopolysaccharide caused by mucopolysaccharide Big identification.
(3) Spleen puncture examination: the risk is large, especially the significant splenomegaly, due to fibrous tissue hyperplasia, the texture becomes hard and brittle, easy to rupture and hemorrhage, so it is not easy to use, it is not commonly used in children, in the case of suspected spleen abscess Can be diagnosed by spleen puncture and pus, can be taken by spleen puncture to obtain living tissue or smear examination to obtain the cause of the disease diagnosis, after surgical laparotomy, laparoscopy or splenectomy, pathological examination can be done to provide a basis for diagnosis. .
9. X-ray examination of chest and bone X-sex examination of respiratory symptoms can be chest radiographs, such as miliary tuberculosis, cranial radiographs on the head to help diagnosis of toxoplasmosis and giant cell inclusion disease, bone photo The tablets contribute to the diagnosis of eosinophilic granuloma, and the head X-ray film reveals a defect indicating Langhansian histiocytosis.
10. Esophageal barium meal, pyelography examination of the esophagus gastrointestinal barium meal examination can observe esophageal varices, to understand the presence or absence of portal hypertension, gastrointestinal barium meal examination, pyelography can help identify the nature of abdominal masses.
11. Splenic portal venography can help to understand whether the splenic vein is deformed, the obstruction of the splenic vein, and assist in the diagnosis of congestive splenomegaly.
12. Radionuclide scanning spleen scintigraphy The application of 99mTc or 113In indium colloid injection after spleen scanning helps to estimate the spleen size and morphology, 51Cr labeled platelets or red blood cells are injected into the body after body surface scan, and the amount of 51Cr in the spleen area is greater than that of the liver 2 ~ 3 times, suggesting excessive destruction of platelets or red blood cells, can provide indications for splenectomy.
13. Ultrasound examination Ultrasound examination of the spleen can be used to determine the size, location, and nature of the spleen, to determine whether the mass is the spleen. At the same time, ultrasound examination is valuable for exploring the size of the spleen and the level of the liquid.
Diagnosis
Diagnosis and diagnosis of splenomegaly in children
First of all, it should be clear whether the spleen is swollen, the degree of swelling, the hardness, the surface is smooth, and then combined with the medical history, other system signs and necessary laboratory tests.
1. History and clinical manifestations
(1) age of onset and family history: congenital hemolytic anemia, early onset, often family history, different diseases have different age of onset, Gaucher disease, Niemann-Pick disease is more common in infants.
(2) History of contact with infectious diseases and epidemiological history: Most patients with schistosomiasis are from schistosomiasis endemic areas, with history of exposure to water, malaria, black fever is often endemic, viral hepatitis, and tuberculosis often has a history of exposure.
(3) Onset and course of disease: bacterial, viral, acute infectious splenomegaly, more rapid onset, splenomegaly can be long or short, and hematologic splenomegasis is long.
(4) Accompanying symptoms:
1 with fever: splenomegaly with fever and spontaneous pain or tenderness caused by infection, common in systemic infectious diseases, such as sepsis, spleen inflammation, spleen abscess, kala-azar, chronic malaria and ascariasis, splenomegaly Lymph node enlargement and fever, mostly caused by viral infection, such as children with acute rash, rubella, sick children with lymphadenopathy, prominent fever, occasional splenomegaly, splenomegaly with fever and lack of evidence, should consider malignant tumors Possible.
2 with anemia, jaundice: mostly hemolytic anemia, spleen and lymph nodes with fever, liver, anemia, bleeding tendency mostly for leukemia, malignant histiocytosis or advanced lymphoma.
3 with gastrointestinal bleeding: considered congestive splenomegaly.
4 pain in the liver and spleen area: liver and spleen area pain has a certain diagnostic value, liver pain indicates intrahepatic inflammation, acute congestion or malignant tumor, spleen area pain is mostly spleen embolism, spleen inflammation, congenital metabolic disorders No pain in the liver and spleen area.
5 other accompanying symptoms: to know whether there are urinary tract symptoms such as urine or hematuria, whether accompanied by neurological symptoms and mental retardation.
In short, splenomegaly is often a component of systemic disease, so the medical history should be comprehensive.
2. Physical examination
(1) Spleen examination: pay attention to the spleen texture, surface smoothness, the location of the spleen, whether there is tenderness, and also pay attention to the identification of the spleen. The splenomegaly can be divided into 3 degrees according to the size.
1 mild swelling: the lower edge of the spleen just touched when deep inhalation (or) less than 3cm below the midline of the clavicle.
2 moderate swelling: the spleen is more than 3cm below the costal margin. The moderate spleen is mostly seen in acute leukemia, various congenital chronic hemolytic anemia, malignant lymphoma and the like.
3 severe swelling (mega spleen): splenomegaly exceeds the umbilical cord, even up to the pelvic cavity, common in advanced schistosomiasis, chronic malaria, chronic myeloid leukemia, congestive splenomegaly, polycythemia vera, myelofibrosis, Gaucher disease, hereditary spherocytosis, thalassemia syndrome, Jacques syndrome, etc.
(2) Pay attention to the signs of diseases related to splenomegaly: check for jaundice, anemia, bleeding points, swollen lymph nodes, liver enlargement, spider mites, signs of liver palm and cirrhosis, presence or absence of abdominal wall venous engorgement, presence or absence Ascites and edema of both lower extremities should be checked for other abdominal masses when suspected of being a tumor. At the same time, the examination of heart, lung and nervous system should not be missed.
