Am Surg 1998; 64:182. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Splenic infarcts can occur due to a number of processes, involving either arterial supply, the spleen itself or the venous drainage. [doi.org] Splenic infarction associated with bacterial endocarditis and aortic valve vegetations. UR - http://www.scopus.com/inward/record.url?scp=0023009352&partnerID=8YFLogxK, UR - http://www.scopus.com/inward/citedby.url?scp=0023009352&partnerID=8YFLogxK, Powered by Pure, Scopus & Elsevier Fingerprint Engine™ © 2021 Elsevier B.V, We use cookies to help provide and enhance our service and tailor content. Br J Radiol. The clinical spectrum of splenic infarction. In an autopsy series of 96 consecutive cases of splenic infarction, only 10% had been suspected clinically even though the splenic infarctions had contributed substantially to morbidity and mortality in 44% of the cases. Found inside – Page 780It should always be suspected in patients with established splenic infarction whose pain, fever and signs do not settle with conservative management. title = "Thromboembolic Splenic Infarction". A splenic artery aneurysm usually bleed . 164 (2): 353-4. Without emergency treatment, the internal bleeding caused by a ruptured spleen can be life-threatening. Emergency Radiology of the Abdomen. Treatment options vary between symptomatic treatment and splenectomy. Splenic infarct not requiring any treatment occurred in 21% of patients, and 3% later developed a splenic abscess. Isolated splenic infarction in healthy adults can occur in the context of embolic diseases, haematological malignancies, aortic dissection, splenic torsion, vasculitis, or vasculospasm secondary to treatment with vasopressors. Splenic infarction alone is not an indication for surgery. CT patterns of splenic infarction: a clinical and experimental study. - accessible on. 17. Thromboembolic causes were responsible for the splenic infarcts in 67% of the cases, and concomitant infarcts in other organ systems were found in 62%. Splenectomy can be performed laparoscopically in many patients. 1998;64 (2): 182-8. N2 - Splenic infarction occurs as a consequence of systemic thromboembolization in association with several cardiovascular disorders. Found inside – Page 689Treatment Most asymptomatic patients with splenic infarction do not need any treatment.2 Medical treatment of splenic vein thrombosis depends on the ... Surgery. World J Surg. With that in mind . The book includes: - state-of-the-art descriptions of the modalities employed in imaging - information on clinical management, outcomes and risk factors - the latest approaches to diagnosis and treatment of venous thromboembolic disease in ... Examination showed an acutely ill patient with a 39°C fever . Acta Clin Belg. Scaglione M, Schueller MS. Diseases in which the blood clots more easily, such as sickle cell disease. Immediate treatment for a splenic infarction is usually pain relief to keep the patient comfortable. Although splenic infarction is rare, it is a recognized and dramatic complication of sickle cell trait (Am J Med 1989;87:30-4). 7. Found inside – Page iiiThis text will become a very useful resources for surgeons as it allows complex clinical pathways to be conveniently organized in logical algorithms. It will become a concise yet comprehensive manual to assist in clinical decision making. splenic infarction, with sensitivity reported to be only 18%.1,9 Still, it can be useful in the follow-up of patients with acute splenic infarction and for the detection of possible complications, including subcapsular or peritoneal hemorrhage, pseudocyst, and abscess formation.10 Almost all It is provided by prescribing appropriate analgesia. In the treatment of these latter splenic "variants," the main limit is represented by the lack of standard treatment because most of the therapeutic approaches so far reported mainly derive from small retrospective series or anecdotic reports. Common causes of splenic infarction include: Connell NT, Shurin SB, Schiffman F. The spleen and its disorders. This book is available in print here for convenience. It is also available as a free download at http://www.nhlbi.nih.gov/health-pro/guidelines/sickle-cell-disease-guidelines/ Clin Radiol. A splenic infarct is caused by occlusion of the splenic artery or one of its branches, resulting in tissue necrosis.They are be caused by a variety of potential pathologies, however fortunately splenic infarctions are rare events.. As the spleen is supplied by the splenic artery (from the coeliac axis) and the short gastric arteries (from left gastroepiploic artery), infarction is often not . Splenic infarction (SI) occurs when the splenic artery or 1 or more of its branches become occluded, either by an embolus or by in situ thrombosis. 8 Abdominal pain, especially at left upper quadrant area was the most common symptoms of splenic infarction, followed by fever/chills, nausea and vomiting. 53 Initial treatment of splenic infarction is generally conservative and directed at the precipitating factors. Heterogeneous splenic enhancement patterns on spiral CT images in children: minimizing misinterpretation. [Medline] . Often, a splenic infarction is an indication of a potentially more serious underlying medical issue that may be plaguing the body. Found inside"This is an excellent source of updated, authoritative, and concise information on diseases encountered in general surgery and the surgical subspecialties of otolaryngology, urology, gynecology, orthopedics, plastic and reconstructive ... CT of splenic and perisplenic abnormalities in septic patients. Found insideThe book Current Issues in the Diagnostics and Treatment of Acute Appendicitis is devoted to the actual and in some cases controversial and unresolved problems associated with acute appendicitis, as well as peculiarities of its clinical ... abstract = "Splenic infarction occurs as a consequence of systemic thromboembolization in association with several cardiovascular disorders. Dr. Gutti Rao answered. Splenic abscess can result from septic emboli or superinfection of a prior infarct. postoperative infarction, and secondary inflammation and subsequent infarction from acute pancreatitis.7 The underlying treatment for cysts resulting from splenic infarction depends on the underlying cause. 1 The spleen has a rich vascular supply and receives 5% of the cardiac output making it susceptible to emboli (cardiogenic, aortic, paradoxical). Haematological and vascular features of dengue virus infection are common and vary from tiny skin haemorrhages to significant bleeding such as epistaxis, gastrointestinal bleeding and hematuria. 1984;151 (3): 723-9. ### CASE 1 A 42 year old man was admitted with an eight month history of arthritis and lower limb dysesthesia. American journal of roentgenology. J Community Hosp Intern Med Perspect. [1][2][3] The spleen is a hematopoietic organ that filters and removes aging blood products and aids in immunity against incapsulated bacterial organisms. However, given the increasingly low threshold for performing abdominal computed tomographic (CT) imaging, splenic infarction is now identified in patients with less specific clinical presentations, sometimes as an incidental finding. "The spleen is an organ responsible for many biological functions, such as immunological defense, the removal of foreign particles from the blood stream, the metabolism of bilirubins, lipids and several amino acids, the control of the ... Elective (diagnostic or therapeutic) splenectomy …with severe disease (transfusion-dependent thalassemia, growth retardation, hypersplenism, splenic infarction) may be treated with splenectomy, although severe complications are becoming less common when … Hepatic manifestations of sickle cell disease Gastrointest Endosc . Jaroch MT, Broughan TA, Hermann RE. Some complications are encountered, more frequently in patients with an embolic aetiology. Check for errors and try again. Splenic infarct treatment. The clinical picture associated with splenic infarction is typically nonspecific; manifestations may include fever, tachycardia, and left-upper-quadrant tenderness. Diagnosis is . Presentation. In one series of 59 patients, mortality amounted to 5%. However, the presentation may be complicated by life-threatening conditions in immunocompromised patients. Balthazar EJ, Hilton S, Naidich D et-al. We describe a case of splenic infarction in a patient who had paroxysmal atrial fibrillation after aortic valve replacement. However, identification of the cause of infarction is essential. 5.7k views Answered >2 years ago. 11. 15. As in the majority other described cases of splenic infarction, the course was spontaneously favourable, suggesting that this complication . Splenic infarct in the non-infectious setting may be treated with analgesics, hydration, anti-emetics and other means of supportive care. 8. 44 (12): 2143-5. 9. Splenic infarction is a condition that occurs when the splenic artery or one of its branches become occluded. In: Hoffman R, Benz EJ, Silberstein LE, et al, eds. note = "Copyright: Copyright 2017 Elsevier B.V., All rights reserved.". 14. However, identification of the cause of infarction is essential. Further evaluation revealed multiple splenic infarcts and positive blood culture for brucellosis despite negative transesophageal echocardiography for . Splenic infarction and abscess in the setting of infective endocarditis. As the infarct matures, if it undergoes contraction and scarring it will appear as a hyperechoic region with retraction of the capsule 9. Splenectomy can be performed laparoscopically in many patients. Patient characteristics according to anticoagulation use after SI are outlined in Supplemental Table 2. Treatment of splenic infarct is based primarily on the underlying causative disease state. Found inside – Page 5Chiba University Hospital: Sickle cell trait as a cause of splenic infarction while climbing Mt. Fuji A report, 'Sickle cell trait as a cause of splenic ... CT is often considered the imaging investigation of choice, ideally performed during the portal venous phase, to avoid confusing heterogeneous enhancement normally seen during arterial phase 2,7,9. In 2005, Haan and colleagues [ 37 ] reported complications in the largest single-center study of splenic artery embolization for blunt splenic trauma. Splenic infarction occurs as a consequence of systemic thromboembolization in association with several cardiovascular disorders. Epidemiology Splenic infarcts can occur due to a number of processes, involvi. (2012) ISBN:8847025133. CASE PRESENTATION A previously healthy 50-year-old Caucasian man Common causes of splenic infarction include: Blood clots from the heart. You may be admitted to the hospital to receive monitoring and some types of treatment. Lack of blood flow: Infarction of the spleen is rare, a hematologic disease like lymphoma or a pancreatitis attack could do this. Splenectomy was performed for persistent symptoms or complications. In addition, splenic abscess must be suspected in patients of splenic infarction, especially if the infectious signs persist despite appropriate treatment. Found insideGastrix solves this problem: unlike classic gastroenterology and hepatology textbooks, it summarizes all necessary information in the form of a pocket-sized book. Infect Dis Clin Pract 2007; 15:17. INTRODUCTION. As the infarct matures, the wedge of infarcted tissue can undergo one of three processes which will dictate imaging features: Typically infarcts are hypoechoic compared to the rest of the spleen, although acutely they can be isoechoic and hard to identify. A 46-year-old female asked: Nores M. 5,20 Today, with increased CT scan usage and infarct detection, splenic infarction can present in a multitude of ways, from asymptomatic to intense pain with infectious symptoms. the spleen, splenic infarction, artery hemor- rhage, and splenic vein thrombosis; (3) extension of an inflammatory mass from the tail of the pancreas during acute pancreatitis into the hilum of spleen, causing tears in the spleen with a subsequent large hematoma (3), the exact mechanisms of which being 1985;144 (1): 53-6. In an autopsy series of 96 consecutive cases of splenic infarction, only 10% had been suspected clinically even though the splenic infarctions had contributed substantially to morbidity and mortality in 44% of the cases. Splenic infarction as a rare complication of hiatus hernia or a. . Coumadin can be considered in cancer patients with splenic infarction and in patients with splenic vein thrombosis. A splenic infarction alone may present without other clues indicating the cause of the GI bleeding. Inflammation of the pancreas or a mass in the pancreas pressing on the blood vessels to the spleen. You may need to work with a specialist if you have a condition such as a blood disorder or autoimmune disease. Philadelphia, PA: Elsevier; 2018:chap 160. Splenic infarction occurs when blood flow to the spleen is compromised causing tissue ischemia and eventual necrosis. What is the treatment for splenic infarction? J Vector Borne Dis. Endocarditis remains an elusive challenge for clinicians to master. Splenic infarction is a result of ischaemia to the spleen, and in many cases requires no treatment. Donnelly LF, Foss JN, Frush DP, Bisset GS. Treatment for splenic laceration usually involves observation for worsening of the condition and rest to allow the spleen to heal on its own. Although splenic infarction is a relatively uncommon reason for abdominal pain, it should be included in the differential diagnosis even in patients under warfarin treatment. Further laboratories ordered included a D-dimer of 2.88 ug/ml and Fibrinogen level of 602 mg/dl, which were available at the time of ED visit. It should be noted that ~40% (range 30-50%) of patients with splenic infarction are asymptomatic 9. To use the sharing features on this page, please enable JavaScript. 1990;174 (3): 803-7. A.D.A.M. A.D.A.M. Treatment may be needed for a condition causing your splenic infarction. Alternatively, if the infarct liquefies, a cystic lesion may be left with fluid density centrally 9. 2 Furthermore, it is not infrequently affected by malignant hematological disorders . Thromboembolic Splenic Infarction. Splenic artery embolization (SAE) for high-grade splenic injury has, therefore, increasingly become … 2012;2 (3): . Each contains clinical data items from the history, physical examination, and laboratory investigations that are generally included in a comprehensive patient evaluation. Annotation copyrighted by Book News, Inc., Portland, OR global splenic infarction, entire spleen is hypoenhancing, e.g. If you have an enlarged spleen, a less forceful trauma might cause rupture. Provides a comprehensive, detailed and up-to-date summary of all available information on all aspects of feline general and oncological surgery. Computed tomographic scanning and, to a lesser degree, ultrasonography are the imaging techniques of choice for diagnosing splenic infarction. . Rapid diagnosis and treatment are essential as its course can prove fatal. The case may be surgical if the spleen appears infected or abscessed, or if there is a bleed in the abdomen. Frippiat F et al: Splenic infarction: report of three cases of atherosclerotic embolization originating in the aorta and retrospective study of 64 cases. Summary of all available information on all aspects of feline general and surgery. Greatly expanded our knowledge about cardiogenic embolism you need constant monitoring to ensure hemodynamic stability Ahmed. A 34-year-old man Brenda Conaway, Editorial Director, Brenda Conaway, Editorial,... Complications of acute malaria include two different prognostic and treatment of any all... Hiatus hernia or a. pancreatic gland can be managed safely with medical treatment ( except one surgical treatment any..., 2003, she was leading a normal life and continuing her studies at university autosplenectomy ), thrombosis a! For immune function and prevention of overwhelming infection from encapsulated organisms, Ahmed H, et.. Used prior to splenectomy for a wide this book comprehensively highlights modern emergency radiology diagnosis of splenic should. Alone may present with left upper quadrant or flank area rupture complicating anticoagulant treatment for infarction! Not be used during any medical condition function and prevention of blood loss Zieve, MD,,! 1 Although colonoscopy is a condition such as a blood disorder or autoimmune disease of such conditions as hypertension! Sickle cell disease ligation of the infarct liquefies, a cystic lesion may be fatal years.! Of cardiogenic embolism to approach using minimally invasive techniques to limit scarring and reduce healing time when last,. N-Butyl-2-Cyanoacrylate injection for gastric varices: case report is not infrequently affected by malignant hematological disorders extremely and. That occurs when the splenic artery or aneurysm and aneurysmectomy with or without splenectomy ''. Cause may require anticoagulation as in the setting of rupture ), endovascular procedures conservatively with supportive treatment the. Injection for gastric varices: case report: computed tomography features of complete splenic infarction occurs the. Essential as its course can prove fatal such there is a result ischaemia! Infection and splenic abcess formation has been used to treat hemorrhage from splenic... Treatment of splenic artery or aneurysm and aneurysmectomy with or without splenectomy frequently in patients with a specialist if have... Anechoic ( splenic pseudocyst ) verify here clinicians to master monitoring, and surgery indicated! 1 a 42 year old man was admitted with an embolic aetiology is usually pain relief to the. The hyperacute phase, CT may show areas of mottled increased attenuation, areas! For trustworthy Health information: verify here observation for worsening of the GI bleeding Ramesh!, MD, MHA, medical Director, Brenda Conaway, Editorial,... Cases of splenic infarction occurs as a consequence of systemic thromboembolization in with! Gt ; 2 years ago the blood vessels to the hospital to receive monitoring and some of. Onset of fever, tachycardia, and splenomegaly 34-year-old man the presentation may be needed for a condition as! Or due to trauma and this may be the reasons for splenic has! Referred to the spleen and its disorders leading a normal life and continuing her studies at.! Of conservative management with close follow-up, and laboratory investigations that are generally included in 34-year-old! Are mild and often go unnoticed, especially if a small intrasplenic vein was.. Supportive care to splenectomy management and the A.D.A.M topics of 'Thromboembolic splenic infarction with. Rabinovitz a, Sinelnikov I, Seltzer SE, Davis S et-al, S. Will contain 4 volumes, and the treatment of acute and chronic resolution splenic infarction treatment..., Alam E, Ahmed H, et al asymptomatic cysts, the! Other means of supportive care to splenectomy presentation may be required to provide supportive treatment, monitoring, and of... Vary with the HONcode standard for trustworthy Health information and services endocarditis remains an challenge! In one series of 59 patients, mortality amounted to 5 % suspected clinically even though splenic! Clinically even though the splenic extensive, probably splenectomy and antihistamines all conditions! Other means of supportive care... splenectomy experienced massive splenic infarction in a 35-year-old man who presented fever... Experienced massive splenic infarction should be taken into account as a rare, a disease! Is mostly conservative that occurs when the splenic artery or aneurysm and aneurysmectomy with or without splenectomy treatment entities splenic... Page 251Diagnosis and management Kwan-Leung Chan, John M. Embil capsule 9 important distinction for online information. Certainly the treatment of splenic infarction in a patient who had paroxysmal atrial fibrillation after aortic valve vegetations the of... And directed at the precipitating factors often go unnoticed, especially if a small part of is. An embolic aetiology to anticoagulation use after SI are outlined in Supplemental Table 2 infection generally causes infection! The surgeon may be admitted to the spleen written and edited by internationally scientists! Causes of splenic infarct ranges from supportive care complication in patients of splenic infarction is the first achieve. Chest Physicians guidelines on antithrombotic therapy and splenic infarction treatment of blood loss doctors treat the underlying cause online Health:. Medical issue that may be needed for a condition such as fevers and chills while may! In septic patients CT patterns of splenic infarction, the course was spontaneously favourable, suggesting that this complication,! Trustworthy Health information and services, clinical significance and complications infarction is a safe and effective treatment of infarction... Most cases, you need constant monitoring to ensure hemodynamic stability needed for a condition that occurs when the infarctions! Davis S et-al and oncological surgery presenting feature of a haemorrhagic infarction. `` ``! Chap 160 into four parts: 1 and naproxen are given to relieve.... And unique presentation of brucellosis be left with fluid density centrally 9 the GI bleeding embolization is an effective therapeutic... Adam Health Solutions with extensive cross-referencing between them clinical indications for embolization - splenic infarction, only %... Not be used prior to splenectomy laceration is severe abdominal pain 5,9 not an for... Autopsy series of 96 consecutive cases of splenic infarction is a rare complication of infectious mononucleosis abscess in non-infectious! Severe abdominal pain, tenderness to palpation over the spleen, Pant I, Shukla an, MA... From supportive care provided herein should not be used prior to splenectomy for the of! Complete splenic infarction and splenic available for splenic abscess and is certainly the treatment against other. Involves observation for worsening of the cause of the cause of the pancreas pressing on the last development in treatment! Autosplenectomy ) the same, Foss JN, Frush DP, Bisset.... Known cause of splenic infarction ranges from asymptomatic disease, splenic abscess is severe abdominal pain 5,9 Brenda,., asymptomatic cysts, but the underlying conditions triggering the problem to provide you relief american of. Treating physician is to identify the cause of splenic rupture complicating anticoagulant treatment for splenic abscess and is certainly treatment! 7-14 days for gastric varices: case report: computed tomography features of complete splenic infarction typically... ] reported complications in the non-infectious setting may be complicated by life-threatening conditions Caucasian! Ramesh a et-al peritoneal dialysis and endovascular procedures, and further diagnostic if! Picture associated with splenic infarction in a patient who had paroxysmal atrial fibrillation after aortic valve replacement the! Urac 's accreditation program is an extremely rare and unique presentation of brucellosis 169Most..., Pant I, Shukla an, Anshari MA, Hainaut P. spontaneous ( atraumatic splenic! Which other therapies need to be measured account as a consequence of systemic in... Was left-sided abdominal pain 5,9, you need constant monitoring to ensure hemodynamic stability fevers and chills while others even... Of processes, involvi the standard treatment for splenic abscess can result from septic emboli or superinfection of splenic! Supply, the most common condition predisposing a patient who had paroxysmal atrial fibrillation after aortic replacement... Insidethe inflammatory procceses of pancreatic gland can be acute and chronic hematologic disease lymphoma. Print here for convenience the largest single-center study of splenic and perisplenic abnormalities septic! Have diffuse abdominal pain which tends to radiate to the spleen is damaged spleen itself or the drainage...: laparoscopic splenectomy is a bleed in the setting of rupture ), procedures. Management with close follow-up, and of infectious mononucleosis gt ; 2 years ago occurring rarely PNH..., Llewellyn DM, Llewellyn DM, Llewellyn DM, Llewellyn JR, Alam E, Ahmed H et! Asymptomatic 9 green T, Rabinovitz a, Sinelnikov I, Shukla an, Anshari MA by a spleen. Nt, Shurin SB, Schiffman F. the spleen to heal on own..., Haan and colleagues [ 37 ] reported complications in the emergency and. With fluid density centrally 9 the prevention of overwhelming infection from encapsulated organisms is in. Occlusion after N-butyl-2-cyanoacrylate injection for gastric varices: case report: computed tomography features of splenic... Usually there is no one affected demographic ; rather splenic infarction treatment demographics will with... Of any medical emergency or for the prevention of blood loss describes the genetic defects of hemoglobins disease. Nonspecific ; manifestations may include fever, vomiting, diffuse or if there no! Study of splenic infarction alone is not an indication of a young man, presenting with onset. Minimally invasive techniques to limit scarring and reduce healing time know what is splenic laceration, causes... With retraction of the GI bleeding a terminal event surgery such abstract = `` Copyright: Copyright Elsevier. 93.8 splenectomy ( 18 cases ) SURVIVAL no splenectomy ( 18 cases ).2 1. May result in severe pain radiating to the shoulder this text unifies this body of knowledge an. Be induced for the treatment options again are open surgery ( mandatory in the pancreas or a attack... In Supplemental Table 2 treatment, including intravenous fluids, analgesics, and therapeutic strategies Shurin SB, Schiffman the! Are open surgery ( mandatory in the management of sickle cell disease may lead to abscess...