An enlarged spleen is a frequent and important clinical sign. It may be a presenting or dominant feature of a number of primary blood diseases as well as other clinical disorders of different etiology. The splenic structure consisting of the white pulp, the red pulp and intermediate marginal zone together with a complicated splenic blood flow enable the spleen to fulfill its functions: filtration (phagocytosis), immunological function, reservoir of blood and its corpuscules and extramedullary hematopoiesis in certain diseases. Enlargement of the spleen may occur as a result of various pathological conditions. This article is based on the history, physical examination and laboratory routine test results as proposed approach to the differential diagnosis of splenomegaly. Progress and changes in management of blood diseases resulted in reappraisal of indications for splenectomy. Progress in surgery has made it possible to perform splenectomy under videolaparoscopic control avoiding laparotomy.

        Key words: Splenomegaly - Pathophysiology - Clinical significance - Diagnosis - Therapy