Q: 54 year old male with ESRD on hemodialysis is admitted to ICU with shortness of breath. ER resident ordered CT scan of chest "just to be safe", which is reported negative for PE. Radiologist commented on some slices from abdomen about splenomegaly. Patient is clinically improving in ICU after session of dialysis. What would be your next step?

A) Call surgery for splenectomy

B) No intervention
C) Work up to rule out lymphoma
D) Work up for underlying portal hypertension
E) Switch from hemodialysis to Peritoneal dialysis

Answer: B (No intervention) 

Splenomegaly in chronic hemodialysis is a normal and regular finding and does not require any intervention unless until it is clinically causing problem. Splenic enlargement is probably due either to red cell damage produced by haemodialysis or to an immunological reaction induced by component of haemodialysis.

Above MCQ also signifies the importance of avoiding unnecessary work up.