Clinical recommendation	Evidence rating	Comments
History of liver disease and alcohol use should be assessed in patients presenting with splenomegaly in the United States.1–3,5	C	Expert opinion based on cirrhosis being one of the most common causes of splenomegaly in the United States
Abdominal ultrasonography is the first-line imaging study suggested to confirm a suspected diagnosis of splenomegaly.3,5,6,8,14	C	Blinded clinical trial and expert opinion based on low sensitivity and specificity of the abdominal examination for splenomegaly and cost of other imaging modalities
Vaccinations against encapsulated organisms are indicated in functionally asplenic patients to prevent infection.24,25	C	Expert opinion based on clinical guidelines and a review article on management of functionally asplenic patients
Patients with infectious mononucleosis should restrict sports participation for at least 21 to 31 days after symptom onset.26,27	C	Sports medicine guidelines based on expert opinion and a retrospective analysis on splenic rupture in patients with infectious mononucleosis and when they are likely to have a rupture