The splenic infarct is often the result of systemic thromboembolism. Acute massive splenic infarction with complete liquefaction of the spleen in sickle cell disease. Do not confuse normal striated enhancement pattern on arterial phase cect for splenic infarct. Sleeve gastrectomy is a restrictive procedure for the treatment of super morbid obesity that is rapidly gaining interest 1.
Malaria and babesia can be associated with splenic infarcts even during low parasitemia. Jan 23, 2019 the splenic infarction can be partial or complete. More recently, surgeons began performing laparoscopic sleeve gastrectomy lsg as the first step in a 2stage procedure for highrisk or super. Jan 01, 2008 we have been unable to find any previous report of splenic infarcts in patients with babesiosis. Click on the link to view a sample search on this topic. Association of splenic and renal infarctions in acute. Cytomegalovirusassociated thrombosis has been extensively reported in the medical literature, mainly in immunecompromised patients. However many cases require nothing more than monitoring. The prognosis varies depending on the underlying cause and whether it is treatable.
Treatment of splenic infarct ranges from supportive care to splenectomy. Interestingly, splenic infarction has been reported in patients with sickle cell trait who were otherwise asymptomatic but presented with left upper quadrant pain after heavy exertion at altitude. Mar 02, 2018 splenic infarction occurs if the blood flow to spleen is obstructed either by a blood clot, a plaque, trauma or infection. To access free multiple choice questions on this topic, click here. Ultrasound has the benefit of being radiation free, relatively fast, and being able to reliably exclude splenomegaly, though some splenic infarcts may be hard to visualize if they are very small andor more centrally located in the abdomen. Splenic infarction synonyms, splenic infarction pronunciation, splenic infarction translation, english dictionary definition of splenic infarction. Systemic lupus erythematosus presenting as splenic. An abdominal ultrasound and ct revealed an extensive splenic infarction. Gard po box 8126, gaithersburg, md 208988126 toll free. Know the causes, signs, symptoms, treatment and diagnosis of splenic infarction. We are reporting a case of plasmodium falciparum malaria with multiple splenic infarcts and its clinical course. A 38yearold black woman presented to the emergency department with 2 days of left upper quadrant abdominal pain, nausea, and intractable vomiting. Splenic infarcts genetic and rare diseases information.
Cytomegalovirusassociated thrombosis has rarely been reported in the medical literature, and if so, mainly in immunocompromized patients. Sometimes, splenic infarction is purposely induced as a treatment method for other medical ailments such as portal hypertension or damages to the spleen. Nov 28, 2018 thromboembolism is another common cause of splenic infarcts. Symptoms of splenic infarct may include sudden onset of persistent leftsided abdominal pain that may travel to the left shoulder. Splenic infarction refers to occlusion of the splenic vascular supply, leading to parenchymal ischemia and subsequent tissue necrosis. The aim of this study was to study the clinical presentation of splenic infarction. Splenic abscesses are felt due to embolized septic material or secondary infection in a patient with bacteremia. Splenic infarction is a condition in which blood flow supply to the spleen is compromised, leading to partial or complete infarction tissue death due to oxygen shortage in the organ. Causes for splenic infarction1 3 include thromboembolic disorders, haematologic disease haemoglobinopathies, leukaemia, lymphoma, myelofibrosis, polycythemia vera, splenic vascular disease, vasculitis, portal hypertension, infiltrative disorders, and pancreatic disease the areas of altered splenic perfusion on ct scan were not due to embolic infarction but to necrosis caused by. Forty splenic infarcts in 23 patients were examined with ultrasound us. The infarct may be segmental, or it may be global, involving the entire organ.
We report the case of a 36yearold caucasian woman with acute cytomegalovirus infection presenting with spontaneous splenic infarcts. Many conditions can cause splenomegaly, such as various infections, liver disease, and cancer splenic infarction. During the acute stage of this disease, the thrombophilic screening revealed reduced free protein s and elevated factor viii, with. Splenic infarct symptoms, diagnosis, treatments and causes. Left axial cect in a sickle cell patient demonstrates an enlarged spleen with multiple wedgeshaped acute splenic infarcts. Pdf acute massive splenic infarction with complete liquefaction of. Scribd is the worlds largest social reading and publishing site. It may not be noticed in the emergency department because the clinical picture is likely to mimic various acute abdominal pains. Splenomegaly can result in hematologic disturbances and abdominal pain and can increase the risk for splenic rupture, which also causes spleen pain, from blunt trauma, resulting in lifethreatening internal bleeding.
For patient 1, the presumed diagnosis at hospital admission was subacute bacterial. Cytomegalovirusassociated splenic infarcts in an adult. Splenic infarction occurs when the splenic artery or one of its branches are occluded, for example by a blood clot. Left upper quadrant pain in pregnancy can be due to a variety of causes and in the septic or unwell patient, splenic infarct. The splenic infarct is often the result of systemic thromboembolism associated with cardiovascular. Splenic infarction usually causes pain in the left upper quadrant of the abdomen, although the pain is occasionally referred to the shoulder. Chronic myeloproliferative disease can also lead to splenic infarction due to massive splenomegaly and a hypercoagulable state 2. Splenic infarct as complication of sleeve gastrectomy. Infarction can occur if there is blockage in splenic artery. Pdf osler taught that splenic infarction presents with left upper abdominal. Splenic infarction an overview sciencedirect topics. Jan 19, 2018 the spleen is a lymphatic organ thats located in the upperleft abdominal quadrant and its main function is to filter out and store both blood cells.
Cocaine has been implicated in ischemic injury to multiple organ systems. The spleen also occupies a central relay role in a positive feedback cycle 6 such that an acute myocardial infarction increases the activity of the sympathetic nervous system, which mobilizes progenitor cells from the bone marrow which then seed the spleen, boost its monocyte production and contribute to inflammation and proteolytic. Splenic infarction occurs when blood flow to the spleen is compromised causing. Acute massive splenic infarction with complete liquefaction of the spleen in sickle cell disease to the editor. We report the case of a 38yearold caucasian man of hellenic origin with acute cytomegalovirus infection presenting with spontaneous splenic infarcts. Splenic infarcts themselves can be complicated by splenic abscess formation. Certain infections and disorders such as cytomegalovirus infection, malaria, infectious mononeucleosis, or inherited clotting disorders can cause plaque formation in the blood vessel. Case report splenic infarct as complication of sleeve gastrectomy andrew p. A small number of cases of splenic infarction have been associated with parvovirus b19 infection, and very few published reports are available on brucellaassociated splenic infarct in the absence of infectious endocarditis. The interruption in the blood supply to the spleen can be caused by an object. The unexpected finding of a splenic infarction in a. We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail.
Abdominal pain is a common complaint among all ages of patients. A thorough clinical examination and imaging studies. The computed tomographic ct appearance of splenic infarction has classically been described as peripheral, wedgeshaped, and low in density. Spleen does not get enough oxygen which can cause ischemia and death of splenic tissue. Tissue death in the spleen, called splenic infarct, is due to a lack of blood flow or a lack of oxygen in. Objectives to describe the contemporary experience of splenic infarction. Oct 15, 2012 larger and more peripheral infarctions are more prone to form abscesses and cause splenic rupture, whereas smaller infarcts may go largely unnoticed and only be detected on incidental imaging. With that said, if you suffer from a specific medical condition or illness that increases your risk of enduring an organ infarction. A small splenic infarction was seen, but the infarcted volume was less than 10% of total splenic volume figure 4a. Splenic infarction due to thrombosis is infrequent. We primarily selected manuscripts published in english and gave particular attention to those from 1980 to 2004 relating splenic infarct or abscess to ie. Splenic infarction is classically associated with bacterial endocarditis and sickle cell disease. Nov 28, 2018 septic thromboemboli may result in splenic abscesses, which present with sepsis and left upper abdominal pain.
Although 10% of splenic infarction is caused by hematologic diseases, it seldom accompanies autoimmune hemolytic anemia aiha. The sonographic bright band sign of splenic infarction. Association of splenic and renal infarctions in acute abdominal emergencies article in european journal of radiology 501. Splenic infarction is a result of ischemia to the spleen, and in many cases requires no treatment. The monarch initiative brings together data about this condition from humans and other species to help physicians and biomedical researchers. Clinical report by journal of vector borne diseases. A case of lymphoma presenting as splenic infarction bmj.
The splenic artery is an end artery and occlusion of the main artery or its branches will usually result in splenic infarction, which may be global or, more commonly, segmental in distribution. The link between splenic sequestration and massive infarction has been noted by several authors. Splenic infarctions may be caused by embolic occlusion of the splenic artery or its branches or may be nonembolic, caused by focal stasis and thrombosis. Splenic infarction is a very rare complication of im due to ebv but should be considered. The vast majority 88%, however, are either infiltrative hematologic diseases that cause congestion of the splenic circulation by abnormal cells, or thromboembolic conditions that produce obstruction of larger vessels. Upper left quadrant abdominal pain is the main symptom, but the clinical presentation can be delayed or even absent in the initial stages. However, identification of the cause of infarction is essential. Splenic infarction is a rare complication of malaria and its clinical course remains incompletely understood. Splenic infarction, defined as ischemia of the spleen due to diminished vascular supply, is a clinical entity that may develop in various hematological, thrombotic, infectious, and neoplastic diseases. Cytomegalovirusassociated splenic infarcts in a female. It is the result of arterial or venous compromise and is associated with a heterogeneous group of diseases. We use cookies to offer you a better experience, personalize content, tailor advertising, provide social media features, and better understand the use of our services. Pdf splenic infarction in a patient with autoimmune.
Symptoms and conditions also mentioned with pain in patients discussions. Acute splenic infarction at an academic general hospital ove. Splenic infarction and splenic vein thrombosis are rare causes of abdominal pain, usually presenting as leftsided abdominal pain associated with fever, nausea or vomiting, and elevated white blood cell count. We report a case of splenic infarction temporally related to cocaine use. Splenic infarction is most commonly caused by cardiovascular thromboembolism. Once completely free, the gastric remnant was placed in a 15mm endocatch bag. Splenic infarction is a condition in which blood flow supply to the spleen is compromised, leading to partial or complete infarction in the organ. In the series of nores et al, most of the patients with thromboembolic infarction were symptomatic.
The etiologies of splenic infarct may be categorized as follows. Unusual presentation of diffuse large bcell lymphoma with. Splenic infarction in the setting of infective endocarditis is common, complicating approximately 35% range 2047% of patients with leftsided infective endocarditis. During the acute stage of this disease, the thrombophilic screening revealed reduced free protein s and elevated factor viii, with normalisation on reevaluation 6 weeks later. Although it can occur asymptomatically, the typical symptom is severe pain in the left upper quadrant of the abdomen, sometimes radiating to the left shoulder. While sickle cell patients can develop a small, calcified autoinfarcted spleen, the spleen may be enlarged in the early stages of the disease. Splenic artery embolization for the treatment of gastric variceal bleeding secondary to splenic vein thrombosis complicated by necrotizing pancreatitis. The operation was first described in 1988 as the initial restrictive component of the duodenal switch procedure 2. We report a case of multiple splenic infarction in a patient with sle. Among his symptoms, he reported abdominal pain in the upper left quadrant.
Pdf on jul 1, 2011, salam alkindi and others published acute massive splenic infarction with complete. Etiology and management of splenic infarction and splenic. The sonographic bright band sign of splenic infarction llewellyn. The spleen in myocardial infarction circulation research. However, the association with splenic infarcts has been rarely mentioned. Blockage can be due to a clot or infection or even a blunt injury to the spleen. Splenic infarction wikimili, the free encyclopedia. Treato found 20 discussions about splenic infarction and pain on the web. Spontaneous atraumatic splenic rupture complicating anticoagulant treatment for splenic infarction. The splenic infarct is often the result of systemic thromboembolism associated with cardiovascular disorders.
Splenic infarcts are rare and result from the occlusion of splenic artery or one of its branches with an embolus secondary to septic emboli from the vegetations on the mitral or aortic valves or less frequently by localized thrombosis as seen in leukemia, myeloproliferative disorders, sickle cell disease, or in vasculitis. Splenic infarction and abscess in the setting of infective e. A retrospective examination of files during a 10year period was conducted. Splenic infarction may be caused by atrial fibrillation, bacterial endocarditis, sickle cell disease, antiphospholipid syndrome, and trauma whereas an infectious etiology is uncommon. Unsurprisingly there is also a probable small renal infarct. Splenic infarction splenic infarction can develop at high altitude, including mountain climbing and flying in unpressurized approach to the child with an enlarged spleen view in chinese relatively mild degrees of hypoxia can cause the irreversible rbc sickling, leading to splenic infarction autosplenectomy. Splenic infarction occurs as a consequence of systemic thromboembolization in association with several cardiovascular disorders. Thank you for your interest in spreading the word about the bmj. Expanding intralienal liquefaction, increasing subcapsular hemorrhage, free peritoneal blood even in spleens shown to have an intact surface at sonography, and flow phenomena in the area of infarction demonstrated at bmode pulsed doppler us were identified as infarct related complications associated with the risk of splenic rupture. Trauma that affects the blood flow to the spleen, either directly or as a result of compression ex. Deep vein thrombosis or pulmonary embolism is more common in immunocompetent patients while splenic infarct is more common in immunocompromised patients. Splenic infarction is a condition in which blood flow supply to the spleen is compromised. In the largest cohort published to date, no splenic involvement is described in wegeners granulomatosis wg.
Although the classic sonographic appearance of an acute splenic infarct is a peripheral wedge. Venous infarction may also occur secondary to splenic or portal vein thrombosis. Background osler taught that splenic infarction presents with left upper abdominal quadrant pain, tenderness and swelling accompanied by a peritoneal friction rub. Ischemic stroke and splenic infarction request pdf. The aim of this study is to present an evaluation of the patients that presented to the emergency department ed with abdominal pain and were diagnosed with splenic infarct. Case report splenic infarct as complication of sleeve. Epidemiology splenic infarcts can occur due to a number of processes, involvin. Two investigations were designed to determine the appearance of splenic infarcts. Splenic embolization may result from various cardiovascular conditions, including a left atrial or ventricular mural thrombus that formed as a result of acute myocardial infarction or atrial fibrillation or developed from complications of cardiac catheterization or bacterial endocarditis.
Acute splenic infarction at an academic general hospital. The area of the spleen affected by loss of blood supply or essentially the regions where the tissue death in the spleen has occurred is known as splenic infarct. Splenic infarction definition of splenic infarction by. However, here we report a female patient on lowdose methotrexate for rheumatoid arthritis who presented with both pulmonary embolism and splenic infarct. The unexpected finding of a splenic infarction in a patient. Information for healthcare providers what are the signs and symptoms of splenic infarct. With that said, if you suffer from a specific medical condition or illness that increases your risk of enduring an organ infarction of any kind. Monarchs tools are designed to make it easier to compare the signs and symptoms phenotypes of different diseases and discover common features.
Splenic infarction after cocaine use annals of internal. Massive splenomegaly may lead to splenic infarction and subsequent splenic rupture. At clinical presentation, splenic infarction was associated with severe left upper quadrant pain n 10 or diffuse abdominal pain n 4 or was asymptomatic n 9. Although new onset left upper quadrant abdominal pain or tenderness and persisting fever and bacteremia suggest splenic infarction or abscess, a high percentage of patients with splenic. Transesophageal echocardiography did not show any vegetations or mural thrombi. It remains unclear whether routine antibiotics for malarial splenic infarcts is required. The authors present a case of a 24yearold man with infectious mononucleosis im due to epsteinbarr virus ebv. Splenic infarction has been reported in association with bevacizumab 106a. Health, general artesunate dosage and administration doxycycline infarction care and treatment infection health aspects malaria complications and side effects. It is considered a rare presentation of acute infectious mononucleosis. Splenic infarction in pregnancy, australian and new zealand. Pdf scrub typhus is a mite borne infectious disease that has the potential to involve multiple organs and can be fatal.
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