From the Guidelines
Treatment for a splenic infarct is primarily supportive care with pain management using NSAIDs or opioids as needed for abdominal pain, and most splenic infarcts resolve on their own without specific intervention. The management of splenic infarct is crucial to prevent complications such as splenic rupture, abscess formation, or pseudocyst development. According to the American Heart Association guidelines 1, splenic infarction is a common complication of left-sided infective endocarditis, occurring in approximately 40% of cases. However, only 5% of patients with splenic infarction will develop a splenic abscess.
Diagnosis and Management
- Clinical splenomegaly is not a reliable sign of splenic infarction or abscess, and imaging techniques such as abdominal CT and MRI are the best tests for diagnosing splenic abscess, with sensitivities and specificities ranging from 90% to 95% 1.
- Patients with persistent or recurrent bacteremia, persistent fever, or other signs of sepsis should be evaluated for splenic abscess.
- Differentiation of splenic abscess from bland infarction may be difficult, but infarcts generally are associated with clinical and radiographic improvement during appropriate antibiotic therapy.
- Ongoing sepsis, recurrent positive blood cultures, and persistence or enlargement of splenic defects on CT or MRI suggest splenic abscess, which responds poorly to antibiotic therapy alone.
Complications and Treatment
- Complications such as splenic rupture, abscess formation, or pseudocyst development are rare but can occur, and patients should seek immediate medical attention for worsening pain, fever, or signs of internal bleeding.
- Surgery (splenectomy) is rarely needed and reserved for cases with complications like abscess, rupture, or persistent symptoms, and percutaneous drainage or aspiration of splenic abscess may be an alternative to splenectomy for patients who are poor surgical candidates 1.
- Definitive treatment for splenic abscess is splenectomy with appropriate antibiotics, and this should be performed immediately unless urgent valve surgery also is planned 1.
From the Research
Definition and Causes of Splenic Infarct
- Splenic infarction is a rare disorder that occurs as a consequence of systemic thromboembolization in association with several cardiovascular disorders 2.
- It can be caused by hematologic disorders, thromboembolic disorders, and other diseases 3.
- The clinical picture associated with splenic infarction is typically nonspecific, with manifestations including fever, tachycardia, and left-upper-quadrant tenderness 2.
Diagnosis and Treatment of Splenic Infarct
- Computed tomographic scanning and ultrasonography are the imaging techniques of choice for diagnosing splenic infarction 2.
- Anticoagulant therapy is associated with decreased long-term mortality in splenic infarction patients, with a 94% improved survival rate 4.
- Splenic artery embolization (SAE) is a treatment approach for high-grade splenic injury, which decreases blood pressure to the spleen to allow healing while preserving splenic perfusion via collateral pathways 5.
- Surgical complications of splenic infarction include abscess and rupture, and surgery may be necessary in cases of clear, persistent symptoms or complications 6, 3.
Symptoms and Prognosis of Splenic Infarct
- Symptoms of splenic infarction include abdominal pain, fever, and chills, with 69% of patients presenting with symptoms 3.
- The overall morbidity rate is 36%, with pulmonary complications being the most frequent, and mortality rate is 5% 3.
- Patients with anticoagulant therapy have a higher event-free survival curve for thromboembolic complications, but do not have a significant difference in bleeding risk 4.