Spleen Pain

What is the spleen?

The spleen is an organ the size of the fist that lies in the upper left abdomen. It is positioned underneath the diaphragm–a flat muscle that divides the abdominal and chest cavity. It is almost completely covered by the ribs, so it normally cannot be palpated.

The spleen contains white blood cells, which fight against microbes, and red blood cells, which are available as a blood pool. It also removes old red blood cells from the circulation.

When severely damage, the spleen can be surgically removed. Individuals without spleen can live normally, but they may be more susceptible to infections, so they may need to take antibiotics regularly.

Spleen Pain Location and Characteristics

• Location: under the left lower part of the rib cage, where your left elbow touches the body when your arms are hanging down
• Pain characteristic: sudden and sharp or, occasionally, deep and constant pain
• Pain triggers: deep inhalation, sneezing or coughing
• Radiation (sometimes): spleen pain can radiate to the left middle back or the tip of the left shoulder blade

Pain is often the only symptom of a splenic disorder but–depending on the cause–it can be accompanied by localized tenderness, early satiety, nausea, vomiting, fever, paleness, fatigue or weigh loss ^[3].

Causes of Splenic Pain

• Splenic infarction–the death of splenic tissue–, which can occur due to ^[1]:
  • Sickle cell disease
  • Leukemia
  • Embolus–a piece of clogged blood formed within the heart (due to irregular heart rhythm, myocardial infarction, endocarditis or prosthetic valves), detached and traveled into the splenic artery and thus obstructing the blood supply to the spleen
  • Trauma
  • Malaria
  • Cocaine use
• Spleen rupture due to a blunt trauma (in car accidents) or during colonoscopy
• Splenic abscess–a collection of pus in the spleen as a result of spread of an infection from another organ

Disorders with an enlarged spleen (splenomegaly), such as lymphoma, leukemia, infectious mononucleosis, malaria, toxoplasmosis, liver cirrhosis, sarcoidosis, rheumatoid arthritis, systemic lupus erythematosus, sickle cell anemia and hemolytic anemia, may cause mild discomfort or sensation of fullness rather than pain ^[3].

Diagnosis

To find out that pain originates in the spleen, a doctor can use:

• Physical examination
• Abdominal ultrasonography
• Computed tomography (CT)
• Magnetic resonance imaging (MRI)

Differential Diagnosis

More commonly than from splenic disorders, upper left abdominal pain is caused by:

• Abdominal bloating
• Trapped gas in the part of the colon near the spleen (splenic flexure syndrome)
• Side stitch during running (more common on the right side; disappears within minutes of rest)
• Hard exercise resulting in overstretched abdominal wall muscles
• Muscle contusion after a direct hit
• Serratus anterior muscle pain
• Myofascial pain syndrome
• Pleurisy, usually caused by pneumonia
• Heart anxiety pain
• A kidney infection, inflammation, stones or other cause of kidney pain
• Acute pancreatitis
• Stomach ulcer or cancer

Rare causes of upper left abdominal pain:

• Adrenal gland tumor
• Abdominal adhesions (after surgery or in endometriosis)
• Broken rib
• An injury of the long thoracic nerve
• Shingles (Herpes zoster)
• Pneumothorax–collapsed lung (spontaneous or traumatic)
• Other causes of side pain

• References

  1. Parikh M, Splenic infarct, overview  Emedicine
  2. Parikh M, Splenic infarct, clinical presentation  Emedicine
  3. Splenomegaly  Merck Manual, Professional Version
  4. Jacob HS, Overview of the spleen  Merck Manual, Consumer Version