Background <p>Shear Wave Elastography (SWE) offers a quantitative tissue stiffness assessment; however, research on its application in splenomegaly has largely focused on chronic liver disease, with limited exploration of other underlying causes and their differentiation.</p> Objective <p>This study aimed at comparing splenic shear-wave elastography findings in patients with splenomegaly based on cirrhotic and non-cirrhotic etiologies.</p> Methods <p>This cross-sectional study was conducted at radiology referral centers from September 2020 to September 2021. Eligible participants included patients with radiologically confirmed splenomegaly, while those with a history of splenic surgery were excluded. Standardized forms were used to collect demographic, clinical, and elastography data. Patients were stratified into two groups for comparative analysis based on splenomegaly etiology: cirrhotic and non-cirrhotic causes.</p> Results <p>The study included 72 participants, stratified into non-cirrhotic (n = 38, 52.8%) and cirrhotic (n = 34, 47.2%) groups. The mean age was 31.65 ± 10.23 years, with a male predominance (68.1%). Spleen size was significantly larger in the cirrhotic group (175.79 ± 35.10 mm vs. 162.26 ± 27.67 mm, <i>p</i> &lt; 0.05). Mean spleen stiffness was 15.06 ± 2.62 kPa overall, with marginally higher values in the non-cirrhotic group (15.53 ± 2.37 kPa vs. 14.53 ± 2.80 kPa). The cirrhotic group exhibited a wider splenic vein diameter (10.35 ± 1.95 mm vs. 9.82 ± 1.37 mm) and higher maximum velocity (15.09 ± 2.82 cm/s vs. 14.05 ± 3.54 cm/s). However, SWE findings showed no statistically significant differences between the two groups.</p> Conclusion <p>Spleen stiffness assessed via SWE did not exhibit significant differences between cirrhotic and non-cirrhotic individuals with splenomegaly.</p>