Original Contribution
Splenic infarction: 10 years of experience

https://doi.org/10.1016/j.ajem.2008.02.014Get rights and content

Abstract

Objective

The aim of this study was to study the clinical presentation of splenic infarction.

Methods

A retrospective examination of files during a 10-year period was conducted. Only computed tomography–proven diagnoses of splenic infarction were included. Signs, symptoms, medical history, and results of investigation were recorded.

Results

We found 49 episodes of acute splenic infarction. Abdominal or left flank pain was the most common symptoms (80%), and left upper quadrant tenderness was the most common sign (35%). Splenic infarction was the presenting symptom of underlying disease in 16.6% of the patients. Based on the computed tomography results, ultrasound was diagnostic only in 18% of patients. There was no in-hospital mortality or serious complications.

Discussion

We present, to the best of our knowledge, the largest series of patients with splenic infarction diagnosed on clinical and radiological grounds. Awareness of the diagnostic possibility of splenic infarction in a patient with unexplained abdominal pain is important because it can be the presenting symptom of potentially fatal diseases.

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

References (14)

There are more references available in the full text version of this article.

Cited by (0)

View full text