From the Guidelines
Splenic infarction is most commonly caused by thromboembolic events, hematologic disorders, and vascular abnormalities, with infective endocarditis being a significant risk factor, as evidenced by the formation of vegetations that can embolize and occlude the splenic artery 1. The causes of splenic infarction can be broadly categorized into several key areas, including:
- Thromboembolic events, such as those originating from atrial fibrillation or endocarditis, which can lead to clot formation that travels to the splenic artery
- Hematologic disorders, including sickle cell disease, polycythemia vera, and leukemia, which can cause increased blood viscosity or abnormal cells blocking small vessels
- Vascular abnormalities, such as splenic artery aneurysm, vasculitis, and iatrogenic causes like splenic artery ligation during surgery
- Infections, like infectious mononucleosis, which can cause splenic enlargement that outgrows its blood supply
- Trauma, which can directly damage splenic vessels According to the American Heart Association, infective endocarditis is a well-established cause of splenic infarction, with approximately 40% of cases resulting in splenic infarction, although only 5% of these cases will develop into splenic abscess 1. It is essential to consider splenic infarction in patients presenting with left upper quadrant pain, especially those with predisposing conditions, and to utilize imaging techniques like CT or ultrasound for prompt diagnosis and management of both the infarction and underlying cause.
From the Research
Causes of Splenic Infarction
The causes of splenic infarction are varied and can be attributed to several factors, including:
- Emboligenic heart disease
- Hematological malignancies
- Solid neoplasia
- Certain infections 2 These causes often determine the treatment given, and understanding the underlying cause is crucial for effective management.
Risk Factors for Venous Thromboembolism
Splenic artery angioembolization has been associated with an increased risk of venous thromboembolism (VTE) 3. Additionally, thrombocytosis, which is common after splenic trauma, can also increase the risk of VTE 4. Extreme thrombocytosis (platelet count >1000×10^9) is particularly associated with an increased risk of VTE.
Management-Related Factors
The management of splenic trauma can also impact the risk of splenic infarction and VTE. Splenectomy, for example, is associated with a higher incidence of thrombocytosis and extreme thrombocytosis compared to spleen-preserving strategies 4. Angioembolization of the splenic artery may also produce a transient systemic hypercoagulable state, increasing the risk of VTE 3.