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2015 ; 94
(36
): e1363
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Acute Splenic Infarction at an Academic General Hospital Over 10 Years:
Presentation, Etiology, and Outcome
#MMPMID26356690
Schattner A
; Adi M
; Kitroser E
; Klepfish A
Medicine (Baltimore)
2015[Sep]; 94
(36
): e1363
PMID26356690
show ga
Few case series provide a current, comprehensive, and detailed description of
splenic infarction (SI), an uncommon condition.Retrospective chart review
complemented by imaging evaluation and patient follow-up.All adult patients with
a confirmed diagnosis of acute SI discharged over 10 years from a single academic
center were studied. A systematic literature review was done to compile a
complete list of SI etiologies.SI was found in 32 patients, 0.016% of admissions.
Ages ranged from 18 to 86 (median 64) years. Cardiogenic emboli were the
predominant etiology (20/32, 62.5%) and atrial fibrillation was frequent. Other
patients had autoimmune disease (12.5%), associated infection (12.5%), or
hematological malignancy (6%). Nine of the patients (28%) had been previously
healthy or with no recognized morbidity predisposing to SI. In 5 of 9 hitherto
silent antiphospholipid syndrome or mitral valve disease had been identified. Two
remained cryptogenic. Most patients presented with abdominal pain (84%), often
felt in the left upper quadrant or epigastrium. Associated symptoms, leukocytosis
or increased serum lactate dehydrogenase occurred inconsistently (?25% each).
Chest X-ray showed suggestive Lt. supra-diaphragmatic findings in 22%. Thus, the
typical predisposing factors and/or clinical presentation should suggest SI to
the clinician and be followed by early imaging by computed tomography (CT),
highly useful also in atypical presentations. Complications were rare and
patients were discharged after 6.5 days (median) on anticoagulant treatment. The
systematic literature review revealed an extensive list of conditions underlying
SI. In some, SI may be the first and presenting manifestation.SI is a rare event
but should be considered in predisposed patients or those with any combination of
suggestive clinical features, especially abdominal pain CT evaluation is
diagnostic and the outcome is good.
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