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. Pathogenesis, clinical manifestations, and diagnosis view in chinese. Splenic infarction splenic infarction can develop at high altitude, including mountain climbing and flying in unpressurized gaucher disease. Splenic infarction should certainly be considered in differential diagnosis of patients presenting to the emergency department due to abdominal pain, in view of underlying and riskposing diseases. Research on splenic infarcts indicates that ultrasound imaging is a method that may be preferred. Splenic infarction and bevacizumab the lancet oncology. Cytomegalovirusassociated splenic infarcts in an adult. Pr3 vasculitis presenting with symptomatic splenic and renal.
Therefore,extensivedivisionofthesgvs increases the likelihood of severing these splenic branches. Cytomegalovirusassociated thrombosis has been extensively reported in the medical literature, mainly in immunecompromised patients. An interruption in the blood supply can result from such things as emboli, thrombi, twisted blood vessels or blood pressure changes, trauma and blood disorders such as leukemia. A case of complete splenic infarction after laparoscopic. When blood flow is obstructed, spleen does not get enough oxygen. The spleen can become infarcted when flow from the splenic artery or one of its branches is interrupted, causing hypoperfusion of splenic segments and eventual tissue death. Splenic infarcts can occur due to a number of processes, involving either arterial supply, the spleen itself or the venous drainage. Pdf osler taught that splenic infarction presents with left upper abdominal quadrant pain, tenderness and swelling. 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. Fadi al akhrass 1, nicole rex 2, asim kichloo 1, larry zhao 1 and muhannad antoun 1 1 infectious diseases and internal medicine departments, pikeville medical center, usa 2 kentucky college of osteopathic medicine, university of pikeville, usa corresponding author. Preserved enhancement of peripheral rim of spleen in massive infarction segmental infarction. Splinter haemorrhages, splenic infarcts, and pulmonary. Article information, pdf download for splenic infarct with scrub.
Splenic infarction occurs if the blood flow to spleen is obstructed either by a blood clot, a plaque, trauma, infection etc. Additional symptoms include fever and chills, nausea and vomiting, pleuritic chest pain, and left shoulder pain kehr sign. Pr3 vasculitis presenting with symptomatic splenic and. Splenic infarct symptoms, diagnosis, treatments and causes. Technical considerations for minimizing the risk of splenic infarct could include dividing the sgvs as close to the. Unsurprisingly there is also a probable small renal infarct. Upper left quadrant abdominal pain is the main symptom, but the clinical presentation can be delayed or even absent in the initial stages. Cytomegalovirusassociated thrombosis has rarely been reported in the medical literature, and if so, mainly in immunocompromized patients. She was diagnosed with cytomegalovirus and human parvovirus b19 concomitant infection. Blood tests showed mild anaemia haemoglobin 10 gdl, pronounced thrombocytopenia, bilirubin 102 moll 66 conjugated, and a positive coombs test. Laparoscopic spleenpreserving distal pancreatectomy lspdp, a newly developed operative procedure, is indicated for benign and lowgrade malignant disease of the pancreas. Splenic infarction after cocaine use annals of internal.
Splenic infarction is a rare complication of malaria and its clinical course remains incompletely understood. Ultrasound is useful if the spleen parenchyma can be identified. She was treated with intravenous ganciclovir for days. Four cases of splenic infarction andor splenic vein thrombosis were identified 4 males, average age of 45 years, range from 38 to 52 years. Physical examination showed tenderness in the leftupper quadrant. We report 2 children with mycoplasma pneumoniae pulmonary infection with splenic infarcts and transient antiphos pholipid antibodies. The link between splenic sequestration and massive infarction has been noted by several authors. Forty splenic infarcts in 23 patients were examined with ultrasound us.
It remains unclear whether routine antibiotics for. However, identification of the cause of infarction is essential. Acute massive splenic infarction with complete liquefaction of the spleen in sickle cell disease to the editor. She had persistent high fever, systemic joint pain, and abnormal liver function. Pubmed is a searchable database of medical literature and lists journal articles that discuss splenic infarcts. An interruption in the blood supply can result from such things as emboli, thrombi, twisted blood vessels or blood pressure changes, trauma and blood disorders such as leukemia and abnormal blood. Examination showed an acutely ill patient with a 39c fever.
However, few studies have reported on postoperative splenic infarction after lspdp. Transesophageal echocardiography did not show any vegetations or mural thrombi. Splenic infarction is a result of ischemia to the spleen, and in many cases requires no treatment. Although it can occur asymptomatically, the typical symptom is severe pain in the left upper.
Focal splenic infarcts occur secondary to embolism or thrombosis and may be associated with inflammatory diseases such as pancreatitis, endocarditis, septicemia, and neoplasia in humans. We report the case of a 36yearold caucasian woman with acute cytomegalovirus infection presenting with spontaneous splenic infarcts. Venous infarction may also occur secondary to splenic or portal vein thrombosis. 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. Multiple case reports of thrombosis associated with cmv have been reported. Spontaneous splenic infarction is a relative rare disease and usually.
There is an increased risk of organ infarction but in many cases this is asymptomatic. We report 2 children with mycoplasma pneumoniae pulmonary infection with splenic infarcts and transient antiphospholipid antibodies. We report the case of a 38yearold caucasian man of hellenic origin with acute cytomegalovirus infection presenting with spontaneous splenic infarcts. Malaria and babesia can be associated with splenic infarcts even during low parasitemia. Fadi al akhrass, infectious diseases and infection. A 27yearold white woman was admitted to our hospital in august, 2002, 12 h after the sudden onset of vomiting, epigastric pain, and fever. The infarct may be segmental, or it may be global, involving the entire organ. A 65yearold man, previously well, presented with a 2 week history of abdominal pain and fever. Case report acute infectious mononucleosis complicated by splenic infarcts. Splenic infarction in acute cytomegalovirus and human. However, the association with splenic infarcts has been rarely mentioned. Hypodense lesions on the periphery of the spleen with a wedgeshaped morphology towards the centre, giving an impression of splenic infarctions. Cmv manifestations can cover a broad spectrum from fever to as severe as pancytopenia, hepatitis, retinitis, meningoencephalitis, guillainbarre syndrome, pneumonia, and thrombosis. For language access assistance, contact the ncats public information officer.
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 splenic infarction occurs when the splenic artery or one of its branches are occluded, for example by a blood clot. A 49yearold man with metastatic sigmoid adenocarcinoma who had received six cycles of chemotherapy with fluorouracil, folinic acid, irinotecan, and bevacizumab was seen in the emergency department with a 36 h history of abdominal pain in the leftupper quadrant. Splenic infarction due a common infection enfermedades. It is the result of arterial or venous compromise and is associated with a heterogeneous group of diseases. Splenic infarction diagnosis involves a multistep process that includes the following practices. Information for healthcare providers what are the signs and symptoms of splenic infarct. To date, 4 cases of babesiosis complicated by splenic infarct have been published, for which the mechanism of infarct remains undefined. Among his symptoms, he reported abdominal pain in the upper left quadrant.
A thorough clinical examination and imaging studies. We present a case report of a 35yearold woman who had splenic infarction. Splenic infarcts genetic and rare diseases information. 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. Spontaneous splenic infarction has been rarely reported as a complication of cirrhosis and portal hypertension. Although once the infarct has become established, both ultrasound and ct are sensitive to the diagnosis, in the hyperacute setting ct with contrast is the modality of choice if the diagnosis is suspected 9. In the largest cohort published to date, no splenic involvement is described in wegeners granulomatosis wg. Splenic infarcts themselves can be complicated by splenic abscess formation. A case of lymphoma presenting as splenic infarction bmj. A 19year old caucasian woman with no past medical history presented on a number of occasions over a. Fadi al akhrass 1, nicole rex 2, asim kichloo 1, larry zhao 1 and muhannad antoun 1 1 infectious diseases and internal medicine departments, pikeville medical center, usa 2 kentucky college of osteopathic medicine, university of pikeville, usa.
Mar 02, 2016 research on splenic infarcts indicates that ultrasound imaging is a method that may be preferred. Splenic infarction refers to occlusion of the splenic vascular supply, leading to parenchymal ischemia and subsequent tissue necrosis. We herein reported a unique case of a 30yearold male patient who developed a splenic infarct during the acute phase of epsteinbarr virus ebvassociated infectious mononucleosis im and was subsequently found to have the presence of antiphospholipid antibodies apa. It remains unclear whether routine antibiotics for malarial splenic infarcts is required. An unusual condition with numerous difficult options. She reported that she had been in good health until the symptoms started. If you have problems viewing pdf files, download the latest version of adobe reader for language access assistance, contact the ncats public information officer genetic and rare diseases information center gard po box 8126, gaithersburg, md 208988126 tollfree. A 38yearold black woman presented to the emergency department with 2 days of left upper quadrant abdominal pain, nausea, and intractable vomiting. Two investigations were designed to determine the appearance of splenic infarcts. We described here the first reported case of pr3 vasculitis presenting with symptomatic bilateral renal wedge infarction.
Unusual presentation of diffuse large bcell lymphoma with. Cytomegalovirusassociated splenic infarcts in a female. Nov 28, 2018 approximately one third of splenic infarcts are clinically occult. Oct 15, 2003 the differential diagnosis of unexplained fever and splenic infarcts in an immunocompetent patient would include embolic events due to endocarditis. Approximately one third of splenic infarcts are clinically occult. Case report splenic infarct as complication of sleeve. The differential diagnosis of unexplained fever and splenic infarcts in an immunocompetent patient would include embolic events due to endocarditis.
Her coagulopathy test revealed no abnormal results. Acute infectious mononucleosis complicated by splenic infarcts. A ddimer test may be used for excluding the diagnosis of splenic infarct. Spontaneous splenic infarction as an uncommon cause of fever in. We report a case of splenic infarction temporally related to cocaine use. The appearance of splenic infarction depends on the timing of imaging and the size of the infarct. Spleen infarction an overview sciencedirect topics. 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. This can cause ischemia and finally death of the splenic tissue or infarction in medical terminology. Thromboembolic causes were responsible for the splenic infarcts in 67% of the cases, and concomitant infarcts in other organ systems were found in 62%. Splenic infarction is a rare cause of abdominal pain. Jan 23, 2019 the splenic infarction can be partial or complete. Spontaneous splenic infarcts in a cirrhotic patient with primary. Splenic infarction must be kept in mind when a patient with cirrhosis presents with left.
The authors present a case of a 24yearold man with infectious mononucleosis im due to epsteinbarr virus ebv. Splenic infarction occurs when blood flow to the spleen is compromised causing tissue ischemia and eventual necrosis. Splenic infarction is a well recognised complication of malaria that has been infrequently reported in the literature. Thorough medical examination and history of the patient to guarantee the most accurate diagnosis. The patient was afebrile and had no recent history of trauma. Symptoms of splenic infarct may include sudden onset of persistent leftsided abdominal pain that may travel to the left shoulder. Histologic diagnosis was splenic infarcts, acute, multifocal to coalescing, severe with thrombosis, consistent with torsion. Anna hospital, via aldo moro 8, 44124, ferrara, italy. Click on the link to view a sample search on this topic. Causes of splenic infarction can be broken down into three main categories. Diagnosis best made on portal venous phase images due to heterogeneous arterial phase enhancement global infarction. Splenomegaly is a common feature in typhus, seen in up to 47% of patients, usually detected by imaging rather than clinic ally. Cocaine has been implicated in ischemic injury to multiple organ systems. Causes, complications, symptoms, prognosis, and treatment.
Splenomegaly and jaundice were present, with no peripheral lymphadenopathy and no clinical evidence of bacterial endocarditis. However, splenic infarction could cause destructive consequences such as hemorrhagic shock, especially in old or weak patients. Case 1, a 45yearold male with sickle cell trait hbs of 38. Ancaassociated vasculitis is a lifethreatening, systemic autoimmune disease. Cytomegalovirus cmv is a type of herpes infection that has a characteristic feature of maintaining lifelong latency within the host cell. 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. The computed tomographic ct appearance of splenic infarction has classically been described as peripheral, wedgeshaped, and low in density. Etiology and management of splenic infarction and splenic.
Embolization of atheromatous debris from the aorta, thrombotic elements from the left ventricle in dilated cardiomyopathy and acute myocardial infarction, and vegetations from infected valves. We are reporting a case of plasmodium falciparum malaria with multiple splenic infarcts and its clinical course. Wedgeshaped or rounded lowattenuation area usually at periphery of spleen can be multiple, especially when caused by. 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. The most common presenting symptom is leftupperquadrant abdominal pain up to 70%.
Know the causes, signs, symptoms, treatment and diagnosis of splenic infarction. Nov 28, 2018 splenic infarction refers to occlusion of the splenic vascular supply, leading to parenchymal ischemia and subsequent tissue necrosis. An abdominal ultrasound and ct revealed an extensive splenic infarction. Rarely can splenic infarction be attributable to scrub typhus. We report a case of complete splenic infarction and obliteration of the splenic artery and vein after lspdp. The splenic infarct is often the result of systemic thromboembolism associated with. A 19year old caucasian woman with no past medical history presented on a number of occasions over a number. If you have problems viewing pdf files, download the latest version of adobe reader. On examination she had petechiae on her nose, and peripheral cyanosis, but we found no other skin lesions, and she had no signs of meningeal irritation. Splenic infarction an overview sciencedirect topics. Mycoplasma pneumoniae, splenic infarct, and transient.