A 64-year-old woman presented with increasingly symptomatic (easy satiety, shoulder pain) splenomegaly (see massive splenomegaly) following years of treatment for polycythemia. Her hematocrit was 32 at the time of evaluation for splenectomy, and her platelet count was 150,000. The size of the spleen is shown, extending down into the pelvis. Note the incidental finding of a long right hepatic lobe (Reidelís lobe) also reaching the pelvis. The patient was vaccinated for pneumococcus, meningococcus and streptococcus in preparation for surgery.