In patients where the likelihood of splenomegaly is high, the physical exam is not sufficiently sensitive to detect it; abdominal imaging is indicated in such patients.In cases of infectious mononucleosis splenomegaly is a common symptom and health care providers may consider using abdominal ultrasonography to get insight into a persons condition. However, because spleen size varies greatly, ultrasonography is not a valid technique for assessing spleen enlargement and should not be used in typical circumstances or to make routine decisions about fitness for playing sports. Causes
The most common causes of splenomegaly in developed countries are infectious mononucleosis, splenic infiltration with cancer cells from a hematological malignancy and portal hypertension (most commonly secondary to liver disease, and sarcoidosis). Splenomegaly may also come from bacterial infections, such as syphilis or an infection of the hearts inner lining (endocarditis). Splenomegaly also occurs in mammals parasitized by Cuterebra fontinella.The possible causes of moderate splenomegaly (spleen <1000 g) are many, and include:

The causes of massive splenomegaly (spleen >1000 g) are

chronic myelogenous leukemia
myelofibrosis
malaria
splenic marginal zone lymphoma

Pathophysiology
Splenomegaly can be classified based on its pathophysiologic mechanism:

Congestive, by pooled blood (e.g., portal hypertension)
Infiltrative, by invasion by cells foreign to the splenic environment (e.g., metastases, myeloid neoplasms, lipid storage diseases)
Immune, by an increase in immunologic activity and subsequent hyperplasia (e.g., endocarditis, sarcoidosis, rheumatoid arthritis)
Neoplastic, when resident immune cells originate a neoplasm (e.g., lymphoma). Diagnosis
Abdominal CT is the most accurate and spleen need to be larger 2-3 times to be palpable below the costal margin in physical examination that can help in diagnosis.
Jumpers knee can be classified into 1 of 4 stages, as follows:Stage 1 – Pain only after activity, without functional impairment
Stage 2 – Pain during and after activity, although the person is still able to perform satisfactorily in his or her sport
Stage 3 – Prolonged pain during and after activity, with increasing difficulty in performing at a satisfactory level
Stage 4 – Complete tendon tear requiring surgical repair
It begins as inflammation in the patellar tendon where it attaches to the patella and may progress by tearing or degenerating the tendon. People present with an ache over the patella tendon. Most people are between 10 and 16 years old. Magnetic resonance imaging can reveal edema (increased T2 signal intensity) in the proximal aspect of the patellar tendon. Causes
It is an overuse injury from repetitive overloading of the extensor mechanism of the knee. The microtears exceed the bodys healing mechanism unless the activity is stopped.Among the risk factors for patellar tendonitis are low ankle dorsiflexion, weak gluteal muscles, and muscle tightness, particularly in the calves, quadriceps muscle, and hamstrings.It may be associated with stiff ankle movement and ankle sprains. Diagnosis
Diagnosis is generally based on symptoms and a physical examination. Ultrasound or magnetic resonance imaging may help clarify how severe the problem is. Treatment
Evidence for treatment is poor. In the early stages rest, ice, compression, and elevation may be tried. Tentative evidence supports exercises involving eccentric muscle contractions of the quadriceps on a decline board. Specific exercises and stretches to strengthen the muscles and tendons may be recommended, e.g.