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Our purpose was to determine if there is an association between nonalcoholic fatty liver and spleen enlargement. Spleen volume was measured by computed tomography (CT) in 32 patients with nonalcoholic fatty liver (23 men and 9 women; age, 41.6 6 12.1, range, 22-69 years) and 34 patients with normal liver (19 men and 15 women; age, 51.1 6 16.2, range, 14-86 years). The values were compared with the patient's demographic data, the liver-tospleen (L/S) ratio of CT Hounsefield unit measurements, and the results of liver function tests. Diagnosis of fatty liver was made if the L/S ratio was less than 1.0. The mean spleen volume was 73.0 6 24.4 cm3 (range, 21.1-106.1) in normal subjects and 141.2 6 54.1 cm3 (range, 44.1-267.3) in patients with fatty liver (P , 0.0001). Multivariate linear regression analysis identified that only the L/S ratio (P , 0.0001) and age (P , 0.01) were significantly correlated with spleen volume. Using forward selection stepwise regression, the L/S ratio entered first (b5 20.634) and age second (b5 20.293). In conclusion, spleen enlargement was commonly seen in patients with nonalcoholic fatty liver, and the recognition of this association may halt further attempts to evaluate the cause of spleen enlargement.
KEY WORDS: fatty liver; spleen; computed tomography.
The number of diabetic or overweight persons with fatty liver is relatively large. Some patients may present with fatigue or vague right upper quadrant pain, and others may have abnormal liver function tests or bright liver on ultrasonography (US) (1). Splenomegaly is reportedly absent in patients with fatty liver, unless liver cirrhosis is present (1).
Spleen volume is increased in advanced cases of liver disease that are associated with portal hypertension. Although the pathogenetic mechanisms of the portal hypertension in advanced liver disease remain controversial, the obstruction or thickening of the terminal hepatic venules (2- 4) or the compression of sinusoids by ballooned hepatocytes (5-9) have been emphasized. In fatty liver, as the amount of lipid increases in the hepatocytes, the lipid droplets coalesce to form larger drops. Then, the hepatocytes containing large single fat drops are enlarged and impede the flow of blood through the hepatic sinusoids. This increased resistance to flow may result in the development of portal hypertension (10). In animal studies...