Splenic infarction

Although it can occur asymptomatically, the typical symptom is severe pain in the left upper quadrant of the abdomen, sometimes radiating to the left shoulder. Fever and chills develop in some cases. It has to be differentiated from other causes of acute abdomen.

An abdominal CT scan is the most commonly used modality to confirm the diagnosis, although abdominal ultrasound can also contribute.{{cite journal |vauthors=Görg C, Seifart U, Görg K |title=Acute, complete splenic infarction in cancer patient is associated with a fatal outcome |journal=Abdom Imaging |volume=29 |issue=2 |pages=224–7 |year=2004 |pmid=15290950 |doi=10.1007/s00261-003-0108-9 |s2cid=31332720 }}{{cite journal |vauthors=O'Keefe JH, Holmes DR, Schaff HV, Sheedy PF, Edwards WD |title=Thromboembolic splenic infarction |journal=Mayo Clin. Proc. |volume=61 |issue=12 |pages=967–72 |date=December 1986 |pmid=3773568 |doi= 10.1016/s0025-6196(12)62638-x}}{{cite journal |vauthors=Frippiat F, Donckier J, Vandenbossche P, Stoffel M, Boland B, Lambert M |title=Splenic infarction: report of three cases of atherosclerotic embolization originating in the aorta and retrospective study of 64 cases |journal=Acta Clin Belg |volume=51 |issue=6 |pages=395–402 |year=1996 |pmid=8997756 |doi= 10.1080/22953337.1996.11718537}}

There is no specific treatment, except treating the underlying disorder and providing adequate pain relief. Surgical removal of the spleen (splenectomy) is only required if complications ensue; surgical removal predisposes to overwhelming post-splenectomy infections.{{cite journal |vauthors=Salvi PF, Stagnitti F, Mongardini M, Schillaci F, Stagnitti A, Chirletti P |title=Splenic infarction, rare cause of acute abdomen, only seldom requires splenectomy. Case report and literature review |journal=Ann Ital Chir |volume=78 |issue=6 |pages=529–32 |year=2007 |pmid=18510036 }}

File:SplenicInfarctUpMark.png

File:Healed splenic infarct.jpg

Several factors may increase the tendency for clot formation, such as specific infections (such as infectious mononucleosis,{{cite journal |vauthors=Suzuki Y, Shichishima T, Mukae M, etal |title=Splenic infarction after Epstein-Barr virus infection in a patient with hereditary spherocytosis |journal=Int. J. Hematol. |volume=85 |issue=5 |pages=380–3 |date=June 2007 |pmid=17562611 |doi=10.1532/IJH97.07208 |s2cid=36770769 }} {{dubious|date=August 2013}}{{Better source|reason=The listed reference is a case study of a single patient with a genetic disorder that already predisposes to spleen problems. I am not familiar with a population study correlating EBV to splenic infarct (rupture yes, infarct no). If anybody is aware of such a study, please include it here. Otherwise this statement is unfounded.|date=August 2013}} cytomegalovirus infection,{{cite journal|last1=Rawla|first1=P|last2=Vellipuram|first2=AR|last3=Bandaru|first3=SS|last4=Raj|first4=JP|title=Splenic Infarct and Pulmonary Embolism as a Rare Manifestation of Cytomegalovirus Infection.|journal=Case Reports in Hematology|date=2017|volume=2017|pages=1850821|doi=10.1155/2017/1850821|pmid=29158925|pmc=5660763|ref=17|doi-access=free}} malaria,{{cite journal |vauthors=Bonnard P, Guiard-Schmid JB, Develoux M, Rozenbaum W, Pialoux G |title=Splenic infarction during acute malaria |journal=Trans. R. Soc. Trop. Med. Hyg. |volume=99 |issue=1 |pages=82–6 |date=January 2005 |pmid=15550267 |doi=10.1016/j.trstmh.2004.06.005 }} or babesiosis{{cite journal |vauthors=Florescu D, Sordillo PP, Glyptis A, etal |title=Splenic infarction in human babesiosis: two cases and discussion |journal=Clin. Infect. Dis. |volume=46 |issue=1 |pages=e8–11 |date=January 2008 |pmid=18171204 |doi=10.1086/524081 |doi-access=free }}), inherited clotting disorders (thrombophilia, such as Factor V Leiden, antiphospholipid syndrome), malignancy (such as pancreatic cancer) or metastasis, or a combination{{cite journal |vauthors=Breuer C, Janssen G, Laws HJ, etal |title=Splenic infarction in a patient hereditary spherocytosis, protein C deficiency and acute infectious mononucleosis |journal=Eur. J. Pediatr. |volume=167 |issue=12 |pages=1449–52 |date=December 2008 |pmid=18604554 |doi=10.1007/s00431-008-0781-3 |s2cid=2702794 }} of these factors.

In some conditions, blood clots form in one part of the circulatory system and then dislodge and travel to another part of the body, which could include the spleen. These emboligenic disorders include atrial fibrillation, patent foramen ovale, endocarditis or cholesterol embolism.

Splenic infarction is also more common in hematological disorders with associated splenomegaly, such as the myeloproliferative disorders. Other causes of splenomegaly (for example, Gaucher disease or hemoglobinopathies) can also predispose to infarction. Splenic infarction can also result from a sickle cell crisis in patients with sickle cell anemia. Both splenomegaly and a tendency towards clot formation feature in this condition. In sickle cell disease, repeated splenic infarctions lead to a non-functional spleen (autosplenectomy).

Any factor that directly compromises the splenic artery can cause infarction. Examples include abdominal traumas, aortic dissection, torsion of the splenic artery (for example, in wandering spleen) or external compression on the artery by a tumor. It can also be a complication of vascular procedures.{{cite journal |vauthors=Almeida JA, Riordan SM |title=Splenic infarction complicating percutaneous transluminal coeliac artery stenting for chronic mesenteric ischaemia: a case report |journal=J Med Case Rep |volume=2 |pages=261 |year=2008 |pmid=18684317 |pmc=2533016 |doi=10.1186/1752-1947-2-261 |doi-access=free }}

Splenic infarction can be due to vasculitis or disseminated intravascular coagulation. Various other conditions have been associated with splenic infarction in case reports, for example granulomatosis with polyangiitis{{cite journal |last1=Langlois |first1=V |last2=Lesourd |first2=A |last3=Girszyn |first3=N |last4=Ménard |first4=JF |last5=Levesque |first5=H |last6=Caron |first6=F |last7=Marie |first7=I |title=Antineutrophil Cytoplasmic Antibodies Associated With Infective Endocarditis |journal=Medicine (Baltimore) |date=January 2016 |volume=95 |issue=3 |pages=e2564 |doi=10.1097/MD.0000000000002564 |pmid=26817911 |pmc=4998285 }} or treatment with medications that predispose to vasospasm or blood clot formation, such as vasoconstrictors used to treat esophageal varices, sumatriptan{{cite journal |vauthors=Arora A, Arora S |title=Spontaneous splenic infarction associated with sumatriptan use |journal=J Headache Pain |volume=7 |issue=4 |pages=214–6 |date=September 2006 |pmid=16767537 |doi=10.1007/s10194-006-0291-5 |pmc=3476041}} or bevacizumab.{{cite journal |vauthors=Malka D, Van den Eynde M, Boige V, Dromain C, Ducreux M |title=Splenic infarction and bevacizumab |journal=Lancet Oncol. |volume=7 |issue=12 |pages=1038 |date=December 2006 |pmid=17138227 |doi=10.1016/S1470-2045(06)70980-9 }}

In a single-center retrospective cases review, people who were admitted to the hospital with a confirmed diagnosis of acute splenic infarction, cardiogenic emboli was the dominant etiology followed by atrial fibrillation, autoimmune disease, associated infection, and hematological malignancy.{{cite journal | last1=Ami | first1=S | last2=Meital | first2=A | last3=Ella | first3=K | last4=Abraham | first4=K | title=Acute Splenic Infarction at an Academic General Hospital Over 10 Years: Presentation, Etiology, and Outcome | journal=Medicine | volume=94 | issue=36 | date=2015-09-11 | pmid=26356690 | pmc=4616622 | doi=10.1097/MD.0000000000001363 | page=e1363}} In spite of those already had risk factors of developing splenic infarction, there were nine beforehand healthy people. And among them, 5 of 9 hitherto silent antiphospholipid syndrome or mitral valve disease had been identified. Two remained cryptogenic.

Splenic infarction can be induced for the treatment of such conditions as portal hypertension or splenic injury.{{cite journal |vauthors=Haan JM, Bochicchio GV, Kramer N, Scalea TM |title=Nonoperative management of blunt splenic injury: a 5-year experience |journal=J Trauma |volume=58 |issue=3 |pages=492–8 |date=March 2005 |pmid=15761342 |doi= 10.1097/01.TA.0000154575.49388.74}} It can also be used prior to splenectomy for the prevention of blood loss.

{{Reflist}}

{{Medical resources

| DiseasesDB = 12365

| ICD10 = {{ICD10|D|73|5|D|70}}

| ICD9 =

| ICDO =

| MedlinePlus = 001293

| eMedicineSubj = article

| eMedicineTopic = 193718

| MeshID = D013159

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{{Hemodynamics}}

{{Lymphatic organ disease}}

Category:Diseases of spleen