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Thromboembolic splenic infarction.

J H O'Keefe, D R Holmes, H V Schaff

    Mayo Clinic Proceedings
    |December 1, 1986
    PubMed
    Summary
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    Splenic infarction, often caused by blood clots from heart conditions, is frequently missed clinically despite significant impact on patient outcomes. Early diagnosis through imaging is crucial for managing this serious condition.

    Area of Science:

    • Cardiology
    • Vascular Surgery
    • Radiology

    Background:

    • Splenic infarction is a recognized complication of systemic thromboembolization, often linked to various cardiovascular disorders.
    • Cardiovascular conditions such as paroxysmal atrial fibrillation and complications post-aortic valve replacement can precipitate thromboembolic events leading to splenic infarction.

    Observation:

    • A case of splenic infarction in a patient with paroxysmal atrial fibrillation following aortic valve replacement is presented.
    • An autopsy series of 96 cases revealed that only 10% of splenic infarctions were clinically suspected, yet they contributed to morbidity and mortality in 44% of cases.

    Findings:

    • Thromboembolic causes accounted for 67% of splenic infarcts, with concomitant infarcts in other organs observed in 62% of cases.
    • Common sources of emboli include atheromatous debris from the aorta, left ventricular thrombi (associated with dilated cardiomyopathy and myocardial infarction), and infected valve vegetations.

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  • Clinical presentation is nonspecific, often including fever, tachycardia, and left-upper-quadrant tenderness.

    • Implications:

    • The high rate of underdiagnosis highlights a significant gap in clinical recognition of splenic infarction.
    • Computed tomography (CT) and ultrasonography are the preferred imaging modalities for diagnosing splenic infarction.
    • Increased clinical suspicion and utilization of advanced imaging are essential for improving outcomes in patients with suspected splenic infarction.