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Splenic septic emboli in endocarditis.

W Ting1, N A Silverman, D A Arzouman

  • 1Department of Surgery, University of Illinois, Chicago.

Circulation
|November 1, 1990
PubMed
Summary
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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.

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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.