Splenic infarction

Background

  • Occlusion (clot or infection) of splenic artery or one or more of its sub-branches


Causes

  • Hypercoagulable state
    • Malignancy
    • Antiphospholipid syndrome
  • Embolic disease
    • Atrial Fibrillation
    • Patent foramen ovale
    • Atheromatous disease
    • Infective endocarditis
  • Myeloproliferative disorders with splenomegaly
    • Polycythemia vera
    • Essential thrombocythemia
    • Primary myelofibrosis
  • Sickle Cell Disease
  • Any splenomegaly
    • Gaucher disease
    • Splenic lymphoma
  • Splenic Trauma
  • Splenic arterial torsion
  • Mononucleosis


Clinical Features[1]

  • Acute LUQ pain (48%)
    • LUQ tenderness (36%)
  • Fever (36%)
  • Nausea or Vomiting (32%)
  • Splenomegaly (32%)
  • Elevated LDH (71%)
  • Elevated WBC (56%)


Differential Diagnosis

  1. Gastritis/gastric ulcer
  2. Herpes Zoster
  3. Pancreatitis
  4. Splenic rupture/distension
  5. Splenic Infarction
  6. Myocardial Ischemia
  7. Pneumonia
  8. Pulmonary Embolism


Workup

  • Abdominal CTA


Management

  • Treat underlying cause
    • Simple cases may require only pain medication
    • Complicated cases may require surgical intervention


Disposition

  • Depends on underlying cause


See Also

  • Abdominal Pain


References

  1. ↑ 48.Lawrence YR, Pokroy R, Berlowitz D, et al. Splenic infarction: an update on William Osler's observations. Isr Med Assoc J 2010; 12:362.
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