What are the common causes of splenic infarction?

Causes of Splenic Infarction

Splenic infarction results primarily from cardioembolic disease (particularly atrial fibrillation), hematologic disorders, and vascular pathology, with the specific etiology varying significantly by patient age. 1, 2

Primary Etiologic Categories

Cardioembolic Causes (Most Common Overall)

• Atrial fibrillation is the leading cause in older patients (>70 years), accounting for 54.4% of all splenic infarctions 2
• Infective endocarditis with valvular vegetations occurs in 40% of left-sided endocarditis cases, with viridans streptococci and S. aureus each responsible for 40% of endocarditis cases 3, 1
• Left ventricular thrombi from dilated cardiomyopathy or acute myocardial infarction are significant embolic sources 4
• Atheromatous debris embolization from the aorta represents another thromboembolic mechanism 4
• Post-cardiac surgery states, including cardiopulmonary bypass and valve replacement procedures, increase embolic risk 1, 4

Hematologic Disorders (15.6% of cases)

• Sickle cell disease or trait is the leading hematologic cause, particularly in young adults 3, 2
• Chronic myeloid leukemia (CML) with hyperleukocytosis and thrombocytosis creates a prothrombotic state 5
• Other myeloproliferative disorders, including polycythemia vera and essential thrombocythemia 6
• Autoimmune hemolytic anemia, though rare, can be associated with splenic infarction 6
• Hereditary spherocytosis and other hemolytic anemias 6
• Leukemia and lymphoma 6

Vascular and Thrombotic Causes (20% of cases)

• Antiphospholipid syndrome occurs exclusively in younger patients and should be actively sought in this population 2
• Splenic vein thrombosis accounts for less than 10% of mesenteric infarction cases and follows Virchow's triad 1
• Vasculitis affecting splenic vessels 1
• Atherosclerosis is common in older patients 2
• Mesenteric dissection and mycotic aneurysm 1
• Anatomic abnormalities of the splenic vasculature 1

Infectious Causes

• Epstein-Barr virus (EBV) infection with associated splenomegaly 1
• Infective endocarditis (5% progress to splenic abscess) 1
• Septic emboli from various infectious sources 3

Iatrogenic and Trauma-Related Causes

• Angioembolization procedures cause major infarctions in 3.7-28.5% of cases 1
• Splenic trauma with direct vascular disruption 1
• Post-surgical states including bariatric surgery complications 1

Other Contributing Factors

• Oral contraceptive use causing acquired thrombophilia 1
• Inflammatory bowel disease with associated thrombotic complications 1
• Protein C deficiency (may be transient) 6
• Solid neoplasms 7

Age-Based Diagnostic Approach

In patients >70 years old: Prioritize evaluation for atrial fibrillation (ECG), atherosclerotic disease, and infective endocarditis (blood cultures, echocardiography) 2

In younger patients: Focus on antiphospholipid syndrome (antiphospholipid antibodies), hematologic disorders (complete blood count with differential, peripheral smear), and sickle cell disease testing 3, 2

Multiple Concurrent Causes

• 21.1% of splenic infarction cases have multiple contributing etiologies, requiring comprehensive evaluation 2
• More than 20% of superior mesenteric artery emboli are associated with concurrent emboli to the spleen and kidney 1
• Concomitant infarcts in other organ systems occur in 62% of thromboembolic cases 4

Critical Diagnostic Considerations

• Splenic infarction represents the initial presentation of a previously unknown medical condition in 38% of patients 2
• Approximately 20% of splenic infarctions are asymptomatic and discovered incidentally 7
• The diagnosis is often missed clinically—only 10% of autopsy-confirmed cases were suspected during life, despite contributing substantially to morbidity and mortality in 44% 4