Splenic infarct presenting as acute abdominal pain in an older patient

A 67-year-old female presented to the Emergency Department with a several hour history of severe pain in the left upper quadrant. A computed tomographic study (CT scan) of the abdomen demonstrated a splenic infarct. The patient was subsequently found to have a patent foramen ovale, with a small right-to-left shunt. This patient's splenic infarct is considered to be embolic in etiology, either from the patent foramen ovale or severe atherosclerotic disease. Patients with left upper quadrant pain who do not have the etiology differentiated by initial testing should be considered to have the potential for splenic infarction. This case illustrates the uncommon occurrence of splenic infarction, presenting as left upper quadrant pain.