A palpable spleen is not necessarily enlarged or pathological.

It is widely accepted that a palpable spleen in the adult population is always enlarged and pathological. The aim of this study was to assess the validity of this statement. As a routine, our protocol for liver-spleen studies includes liver pliability, which demonstrates the level of the hemidiaphragms at full inspiration and expiration, as well as splenic size and colloidal uptake. Sixteen hundred 99mTc sulphur colloid liver-spleen studies, which had been performed in our Department, were reviewed. In 21 patients, who had been referred with "splenomegaly for investigation", the scintigraphic splenic size was 13 cm posterior length or less. In this group, splenic palpability was confirmed by at least two clinicians. Follow-up did not reveal any evidence of splenic disease in 18 of the 21 patients. In a separate postmortem follow-up of 123 sequential liver-spleen scans, 100 patients were noted to have a scintigraphic splenic size of 13 cm posterior length or less. This was shown to be a reliable upper limit of normal because 98% of spleens in this group weighed 250 g or less and were normal at post-mortem examination. This study demonstrates that a palpable spleen is not necessarily enlarged or pathological.