Diagnosis of Splenomegaly

To the Editor.—  In their article "Splenomegaly: An Algorithmic Approach to Diagnosis" (1981;246:2858), Edward R. Eichner, MD, and C. L. Whitfield, MD, recommend bone marrow aspiration, biopsy, and culture for patients with asymptomatic splenomegaly and normal peripheral blood smears and counts. Following normal bone marrow examination they suggest a splenic computed tomographic (CT) scan, arteriography, and finally "consideration" of diagnostic splenectomy and laparotomy. However, they note that 3% of healthy college freshmen have been reported to have asymptomatic splenomegaly¹ and, therefore, it is a rather common finding. A ten-year follow-up study of those same students² failed to reveal any major disease when compared with a similar control group. Conspicuously absent from the group were the lymphoproliferative diseases. In light of this study it would seem excessively invasive and costly to submit 3% of the freshmen college population to bone marrow aspirations, splenic CT scans, arteriograms, and "considerations" of