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Splenic septic emboli in endocarditis
W Ting1, N A Silverman, D A Arzouman
1Department of Surgery, University of Illinois, Chicago.
Insights
Septic emboli frequently affect the spleen in patients with left-sided infective endocarditis. Abdominal computed tomography is crucial for diagnosing splenic complications, guiding management decisions like splenectomy.
Area of Science:
- Cardiology
- Infectious Diseases
- Radiology
Background:
- Septic emboli are a known complication of infective endocarditis.
- Left-sided infective endocarditis commonly leads to systemic embolization, including to the spleen.
Purpose of the Study:
- To investigate the incidence and management of splenic infarcts and abscesses caused by septic emboli in patients with left-sided infective endocarditis.
- To evaluate the diagnostic utility of abdominal computed tomography and the outcomes of splenectomy in these patients.
Main Methods:
- Retrospective review of 108 patients with left-sided infective endocarditis who underwent valvular surgery between 1980 and 1988.
- Analysis of patient records, including etiology, causative organisms, imaging findings, and surgical interventions.
Main Results:
- Splenic infarcts and abscesses occurred in 19% of patients, with intravenous drug abuse being the primary etiology (68%).
- Abdominal computed tomography demonstrated 100% diagnostic accuracy for splenic septic emboli sequelae.
- Splenectomy was performed in 50% of affected patients, with indications including persistent sepsis and large lesions; perioperative mortality was 30%.
Conclusions:
- Splenic septic emboli are a common complication in infective endocarditis.
- Abdominal computed tomography is recommended for all patients with endocarditis to detect splenic involvement.
- Management strategies for splenic septic emboli require careful consideration, as splenectomy carries significant mortality risk.
Abstract:
The significance of septic emboli to the spleen is inferred by the frequency of septic emboli in general seen in patients with left-sided infective endocarditis who are referred for valve replacement. To determine the proper management of splenic infarcts and abscess due to septic emboli, we retrospectively reviewed the records of 108 patients with left-sided endocarditis who underwent valvular surgery at the University of Illinois Hospital from 1980 through 1988. Intravenous drug abuse was the etiology in 68% (n = 73). The incidence of splenic infarcts and abscess was 19% (n = 20), but an incidental finding of splenic infarcts was found in 38% (n = 11) of 29 asymptomatic patients who had computed tomograms. Streptococci and staphylococci were the causative organisms in 85% (n = 17). Localized findings were absent in 90% of splenic infarcts and abscesses. Abdominal computed tomograms were diagnostic of the sequelae of splenic septic emboli in 100%. No patient had intra-abdominal bleeding complications associated with cardiopulmonary bypass. Splenectomy was performed in 50% (n = 10) of patients 3-24 days (mean, 11.2 days) after valve replacement. Indications for splenectomy included persistent sepsis in 60% (n = 6), large (greater than 2 cm) and peripheral lesions in 30% (n = 3), and splenic rupture in 10% (n = 1). Perioperative mortality of patients who underwent splenectomy was 30% (n = 3). The following conclusions can be drawn: 1) Splenic septic embolus is common in endocarditis. 2) Abdominal computed tomography should be performed for all patients.(ABSTRACT TRUNCATED AT 250 WORDS)