What is a splenic infarction (infarct)?

From the Guidelines

A splenic infarct is a condition where a portion of the spleen tissue dies due to inadequate blood supply, often caused by embolized vegetations from infective endocarditis, as noted in the American Heart Association statement 1. This occurs when one or more blood vessels supplying the spleen become blocked, preventing oxygen and nutrients from reaching the affected area. According to the study published in Circulation 1, splenic infarction is a common complication of left-sided infective endocarditis, occurring in approximately 40% of cases.

Key Points

• Common causes of splenic infarct include blood clots, emboli from heart conditions like infective endocarditis, as discussed in the American Heart Association statement 1.
• Patients typically experience sudden left upper abdominal pain that may radiate to the left shoulder, along with fever, nausea, and vomiting.
• Diagnosis usually involves imaging techniques such as abdominal CT and MRI, which have sensitivities and specificities ranging from 90% to 95% for diagnosing splenic abscess, as reported in the study 1.
• Treatment depends on the underlying cause and severity, with most splenic infarcts being managed conservatively with pain medication, hydration, and treating the underlying condition.
• Severe cases with complications like abscess formation or rupture may require surgical intervention, including partial or complete removal of the spleen, as recommended in the study 1.

From the Research

Definition and Overview of Splenic Infarct

• A splenic infarct, also known as splenic infarction, refers to the death of tissue in the spleen due to a lack of blood supply 2, 3, 4.
• This condition can be caused by various factors, including embolic events, hematological malignancies, solid neoplasia, and certain infections 4, 5.

Etiology of Splenic Infarction

• The most common causes of splenic infarction include:
  • Emboligenic heart disease, such as atrial fibrillation 4.
  • Hematological malignancies, such as lymphoma or leukemia 4, 5.
  • Solid neoplasia, such as cancer 5.
  • Certain infections, such as infective endocarditis 3.
• Other potential causes of splenic infarction include autoimmune diseases, such as antiphospholipid syndrome, and thromboembolic events 4, 5.

Clinical Presentation and Diagnosis

• Patients with splenic infarction often present with abdominal pain, typically in the left upper quadrant or epigastrium 4.
• Other symptoms may include leukocytosis, increased serum lactate dehydrogenase, and suggestive findings on chest X-ray 4.
• Computed tomography (CT) scan is a highly useful diagnostic tool for splenic infarction, especially in atypical presentations 4.

Treatment and Outcome

• Treatment for splenic infarction typically involves anticoagulant therapy, which has been shown to improve survival and reduce the risk of thromboembolic complications 2.
• However, anticoagulation may also be associated with increased mortality in certain patient populations, such as those with splenic injury 6.
• The outcome for patients with splenic infarction is generally good, with most patients being discharged after a short hospital stay 4.