In children, a palpable spleen may occasionally be due to visceroptosis rather than true splenomegaly. This distinction is important to make so that extensive investigations for the cause of splenomegaly are not undertaken unnecessarily. Visceroptosis may result from congenital or acquired defects in the supporting mechanism responsible for maintaining the spleen in the correct position. The visceroptosed spleen may be felt anywhere from the upper abdomen to the pelvis and may undergo torsion. When the spleen is felt in the upper abdomen, it can easily be pushed under the left costal margin. This finding is helpful in diagnosing visceroptosis and in differentiating it from true splenomegaly.
In addition to this finding, an abdominal radiograph in the upright position may reveal intestinal gas bubbles between the left dome of the diaphragm and the spleen. This sign may be helpful in suggesting the diagnosis. Splenic scans with 99mTc-sulfur colloid and CT are helpful in defining the position of the spleen more precisely.
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