[Diagnosis of acute splenic infarction by echo-signal-enhanced ultrasound]

A 35-year-old patient with known mitral valve endocarditis presented with a stabbing pain in the left upper abdomen (patient 1). A 79-year-old patient with a history of chronic lymphocytic leukaemia (CLL) and aortic valve replacement presented with acute left upper quadrant, chest pain and impaired vision (patient 2).

An abdominal ultrasound revealed nonhomogeneous hypoechoic splenic lesions in both patients, which were classified as extended splenic infarctions by echo enhancer studies. The diagnosis was confirmed by computed tomography. Transesophageal echocardiography showed extensive mitral valve vegetations in patient 1. Patient 2 had a progression of the CLL without evidence of endocarditis. Magnetic resonance imaging of the brain showed infarction of the posterior cerebral artery area.

Patient 1: Mitral valve endocarditis with embolic splenic infarction. Patient 2: Progressive CLL with thrombotic splenic and brain infarction. In patient 1, mitral valve replacement was performed. In patient 2, chemotherapy was initiated and she was started on low molecular weight heparin s. c. and aspirin. No further embolic or thrombotic complications occurred. No splenectomy was performed.

A splenic infarction is a complication pointing towards an underlying serious disorder. Echo-enhanced ultrasound is as sensitive as computed tomography for early diagnosis. Splenic infarction should trigger urgent treatment of the underlying condition.