Splenic infarction

Splenic infarction
Two large splenic infarcts, as demonstrated on an abdominal CT scan (white arrows) in a 36-year-old Caucasian woman with acute cytomegalovirus infection. The patient was also found to be heterozygous for the Factor V Leiden mutation.
ICD-10	D73.5
DiseasesDB	12365
MedlinePlus	001293
MeSH	D013159

Splenic infarction Microchapters
Home
Overview
Historical Perspective
Classification
Pathophysiology
Causes
Differentiating Splenic Infarction from other Diseases
Epidemiology and Demographics
Risk Factors
Screening
Natural History, Complications and Prognosis
Diagnosis
History and Symptoms
Physical Examination
Laboratory Findings
Electrocardiogram
Chest X Ray
CT
MRI
Ultrasound
Other Imaging Findings
Other Diagnostic Studies
Treatment
Medical Therapy
Surgery
Primary Prevention
Secondary Prevention
Cost-Effectiveness of Therapy
Future or Investigational Therapies
Case Studies
Case #1
Splenic infarction On the Web
Most recent articles
Most cited articles
Review articles
CME Programs
Powerpoint slides
Images
American Roentgen Ray Society Images of Splenic infarction All Images X-rays Echo & Ultrasound CT Images MRI
Ongoing Trials at Clinical Trials.gov
US National Guidelines Clearinghouse
NICE Guidance
FDA on Splenic infarction
CDC on Splenic infarction
Splenic infarction in the news
Blogs on Splenic infarction
Directions to Hospitals Treating Splenic infarction
Risk calculators and risk factors for Splenic infarction

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] ; Associate Editor-In-Chief: Cafer Zorkun, M.D., Ph.D. [2]

Diagnosis

Imaging Studies

Radiological imaging tests are diagnostic. Ultrasound imaging is useful in cases where the splenic parenchyma can be visualized, but significant amount of luminal bowel gas, as well as morbid obesity, render this modality less useful.

• Computerized tomography scan is the current diagnostic modality of choice. Prior to the CT era, diagnosis of splenic infarct was made most commonly at laparotomy for intra-abdominal catastrophe or on postmortem examination. An abdominal CT scan is the most commonly used modality to confirm the diagnosis, although abdominal ultrasound can also contribute. In CT; focal infarcts appear as wedge-shaped areas of decreased attenuation that extend to the surface of the spleen. Global infarction can manifest as diffuse areas of decreased attenuation in the spleen and can mimic splenic abscess or tumor. In some cases of global infarction, the splenic periphery remains enhanced due to perfusion from capsular vessels.

Patient #1 Note peripheral enhancement due to perfusion from capsular vessels

Images courtesy of RadsWiki

• 
  CT: Splenic infarction
• 
  CT: Splenic infarction
• 
  CT: Splenic infarction

Patient #2 Note peripheral enhancement due to perfusion from capsular vessels

Images courtesy of RadsWiki

• 
  CT: Splenic infarction
• 
  CT: Splenic infarction
• 
  CT: Splenic infarction

• Contrast studies clearly depict the classic segmental wedge-shaped, low-attenuation defect. Less frequently, the entire spleen may be infarcted, leaving only a rim of contrast-enhancing capsule.

• Other modes of diagnosis include radioisotope scans and ultrasound evaluation of the spleen.

• Angiography is indicated when a vascular lesion is suspected as the etiologic cause, as in cases of arterial embolization, or to manage segmental bleeding by embolization.

• Magnetic resonance imaging is another useful modality that clearly identifies infarcted splenic parenchyma. Magnetic resonance images may be reconstructed easily in 3 dimensions (as can spiral CT scan images) if the images are obtained using gadolinium contrast.

Source

• Guth AA, Pachter HL, Kaplan LJ et. al., Splenic Infarct, [3]

Additional Resources

• Argiris A: Splenic and renal infarctions complicating atrial fibrillation. Mt Sinai J Med 1997 Sep-Oct; 64(4-5): 342-9[Medline].
• Balcar I, Seltzer SE, Davis S: CT patterns of splenic infarction: a clinical and experimental study. Radiology 1984 Jun; 151(3): 723-9.
• Cohen BA, Mitty HA, Mendelson DS: Computed tomography of splenic infarction. J Comput Assist Tomogr 1984 Feb; 8(1): 167-8.
• Desai DC, Hebra A, Davidoff AM: Wandering spleen: a challenging diagnosis. South Med J 1997 Apr; 90(4): 439-43.
• Franklin QJ, Compeggie M: Splenic syndrome in sickle cell trait: four case presentations and a review of the literature. Mil Med 1999 Mar; 164(3): 230-3.
• Goerg C, Schwerk WB: Splenic infarction: sonographic patterns, diagnosis, follow-up, and complications. Radiology 1990 Mar; 174(3 Pt 1): 803-7.
• Jaroch MT, Broughan TA, Hermann RE: The natural history of splenic infarction. Surgery 1986 Oct; 100(4): 743-50.
• Kluger Y, Paul DB, Townsend RN: Enhanced rim around infarcted, traumatized spleen on computed tomographic scans: case report. J Trauma 1994 Mar; 36(3): 436-7.
• Lo AY, Reich H, Harvey J: Splenic infarction associated with adult respiratory distress syndrome. Mt Sinai J Med 1994 Sep; 61(4): 369-71.
• Nores M, Phillips EH, Morgenstern L: The clinical spectrum of splenic infarction. Am Surg 1998 Feb; 64(2): 182-8.
• O'Keefe JH Jr, Holmes DR Jr, Schaff HV: Thromboembolic splenic infarction. Mayo Clin Proc 1986 Dec; 61(12): 967-72.
• Pachter HL, Hofstetter SR, Elkowitz A: Traumatic cysts of the spleen--the role of cystectomy and splenic preservation: experience with seven consecutive patients. J Trauma 1993 Sep; 35(3): 430-6.
• Pachter HL, Guth AA, Hofstetter SR: Changing patterns in the management of splenic trauma: the impact of nonoperative management. Ann Surg 1998 May; 227(5): 708-17; discussion 717-9.
• Shackford SR, Wald SL, Ross SE: The clinical utility of computed tomographic scanning and neurologic examination in the management of patients with minor head injuries. J Trauma 1992 Sep; 33(3): 385-94.
• Sheikha A: Splenic syndrome in patients at high altitude with unrecognized sickle cell trait: splenectomy is often unnecessary. Can J Surg 2005; 48: 377-381.
• Torda A: Postpartum toxic shock syndrome associated with multiple splenic infarcts. Med J Aust 2005; 182: 93.
• Walcher F, Schneider G, Marzi I: Torsion of a wandering spleen after blunt abdominal trauma. J Trauma 1997 Dec; 43(6): 983-4.
• Yu LK, Hsu CW, Liu NJ: Splenic infarction complicated by splenic artery occlusion after N-butyl-2-cyanoacrylate injection for gastric varices: case report. Gastrointest Endosc 2005; 61: 343-345.