Original ContributionSplenic infarction: 10 years of experience
Introduction
Splenic infarction is an uncommon antemortem diagnosis [1]. The clinical presentation can mimic other causes of acute abdominal pain. A review of the literature revealed a few series of splenic infarction [1], [2], [3], [4]. Single case reports are still published in peer-reviewed medical journals [5], [6], [7], [8], [9], [10], [11], [12], [13], [14], emphasizing that the diagnosis of splenic infarction is far from obvious for emergency physicians. The goal of this study was to review our hospital's 10-year experience with patients with the diagnosis of splenic infarction, compare our experience with previously published series, and characterize the clinical presentation of this condition to improve future diagnostic acumen in such patients.
Section snippets
Study design
This is a retrospective case series of patients who presented to the department of emergency medicine (ED) and were discharged from an inpatient hospitalization with an International Classification of Diseases, Ninth Revision discharge diagnosis of splenic infarction between January 1, 1996, and May 31, 2007.
Setting
The study was conducted at 2 university hospitals with approximately 60 000 and 70 000 annual admissions, respectively. One of the hospitals functions primarily as a community hospital.
Selection of participants
Results
The mean ± SD age of the 48 patients comprising our series was 54 ± 19 years, and the female-male ratio was 1:1.3.
Presenting symptoms and signs are summarized in Table 1. Eighty percent of the patients presented to the ED with either abdominal or left flank pain. The most frequent symptom was left upper quadrant (LUQ) pain (33%). Pleuritic chest pain was reported in 8 patients (16%). Fever and chills were present in 14 patients (27%).
Left upper quadrant tenderness was the most common sign but
Discussion
Splenic infarction is a relatively uncommon diagnosis. O'Keefe et al [1] reviewed a large autopsy series and found that only 10% of splenic infarctions had been diagnosed antemortem. To date, only 4 large series relating to this condition have been published [1], [2], [3], [4], but they differ methodologically from our work. The series by Goerg and Schwerk [4] from Marburg included 23 patients diagnosed by means of ultrasound only. The other series are based mainly on pathological or autopsy
Conclusion
Splenic infarction is an uncommon diagnosis that is often overlooked. Because it can be the presenting symptom of other underlying illnesses, a high index of suspicion for this condition is appropriate in the presence of predisposing conditions for thrombosis, LUQ and/or left flank pain, and splenomegaly with fever without a definitive source. The best diagnostic tool is CT scan. The role of D-dimer warrants further exploration, as well as the prevalence of infarction of the spleen in EBV/CMV
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