Splenic infarction: an update on William Osler's observations

Area of Science:

• Internal Medicine
• Hematology
• Cardiology

Background:

• Classical teaching describes splenic infarction presenting with left upper quadrant pain, tenderness, swelling, and peritoneal friction rub, often linked to bacterial endocarditis or sickle cell disease.
• This study aimed to describe the contemporary clinical experience of splenic infarction.

Discussion:

• The study reviewed 26 inpatient cases of splenic infarction from 1990-2003.
• Common etiologies included hematologic malignancy and intracardiac thrombus, with bacterial endocarditis being less frequent than classically taught.
• A significant proportion of patients (21/26) had splenic infarction as the first indication of an underlying disease.

Key Insights:

• Contemporary splenic infarction presentation deviates from classical signs; localized pain and tenderness were reported in only about half of the cases.
• Systemic signs like fever (36%), leukocytosis (56%), and elevated lactate dehydrogenase (71%) were common.
• Single splenic infarcts were more frequently associated with fever and leukocytosis compared to multiple infarcts.

Outlook:

• Splenic infarction in the modern era requires a broader differential diagnosis than traditionally recognized.
• Investigation of unexplained splenic infarction often leads to the discovery of new underlying conditions.
• Further research may elucidate specific diagnostic markers and management strategies for contemporary splenic infarction presentations.