We report the case of a 38yearold caucasian man of hellenic origin with acute cytomegalovirus infection presenting with spontaneous splenic. The arterial supply to the spleen consists of the splenic artery a branch of the celiac axis and the short gastric arteries branches of the left gastroepiploic artery, which supply the upper pole of the spleen. These infarcts may be the only ct finding of blunt splenic trauma and occur without any adjacent free fluid. The aim of this study was to study the clinical presentation of splenic infarction. Treatment of splenic infarct ranges from supportive care to splenectomy. 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. Ultrasound is useful if the spleen parenchyma can be identified. 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. Splenic infarction occurs when blood flow to the spleen is. Splenic rupture with an intraperitoneal hematoma may present with. 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. Multiple splenic infarcts were detected in 21 patients 43%, of whom 9 also had infarction in other target organs. Splenic infarction in the setting of infective endocarditis is common, complicating approximately 35% range 2047% of patients with leftsided infective endocarditis. Jan 23, 2019 the splenic infarction can be partial or complete.
Eightyeight percent of splenic infarcts are caused by hematological problems such as blood cancers, hypercoagulable states, atrial fibrillation and vasculitides. Included were all adult patients 16 years with computed tomography ctproven diagnosis of splenic infarction. Altituderelated specific infarction in sickle cell traitcase reports of a father and son. 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. The spleen is delivered to the midline by means of blunt and sharp dissection of the areolar plane between the kidney and the pancreas.
It is the result of arterial or venous compromise and is associated with a heterogeneous group of diseases. Multiple case reports of thrombosis associated with. Symptoms of splenic infarct may include sudden onset of persistent leftsided abdominal pain that may travel to the left shoulder. The majority 54% had 2550% infarction of the spleen. Ct scan demonstrated number of splenic infarcts and a large splenic liquefied haematoma. While sickle cell patients can develop a small, calcified autoinfarcted spleen, the spleen may be enlarged in the early stages of the disease. Transesophageal echocardiography did not show any vegetations or mural thrombi. Cytomegalovirusassociated splenic infarcts in an adult. Splenomegaly with fever typhoid,malaria,kala azar,military tuberculosis, infective endocarditis,leukemia,lymphoma 3. Thromboembolic causes were responsible for the splenic infarcts in 67% of the cases, and concomitant infarcts in other organ systems were found in 62%. Autosplenectomy can be painless or present with recurrent episodes of abdominal pain due to multiple infarcts. Depends on the timing of the trauma and when the patient was scanned due to the organization and reliquification of blood.
With the spleen retracted medially, the phrenicocolic ligament is. The mean age of patients was 32 years and the most common mechanism of injury was road traf. We report the case of a 38yearold caucasian man of hellenic origin with acute cytomegalovirus infection presenting with spontaneous splenic infarcts. Splenic vein thrombosis, most commonly the result of pancreatitis or surgery, can result in venous infarction. He has had workups which showed no evidence of endocarditis. Case report splenic infarct as complication of sleeve. Splenic infarction is an uncommon cause of acute abdomen. It remains unclear whether routine antibiotics for malarial splenic infarcts is required. The interruption in the blood supply to the spleen can be caused by an object. Full textfull text is available as a scanned copy of the original print version. A case of splenic lymphoma with marked diffuse nodular fibrosis and calcification, complicated with severe autoimmune hemolytic anemia. Splenic infarction is a rare entity in the paediatric age that, when found, is associated with other predisposing factors such as oncological, haematological or infectious diseases.
Abdominal pain is a common complaint among all ages of patients. Causes, complications, symptoms, prognosis, and treatment. Causes include hematologic disease such as leukemia, lymphoma, myelofibrosis, polycythemia. However, identification of the cause of infarction is essential. Incidental finding of a small splenic lesion in a patient investigated for sepsis. The most common presenting symptom is leftsided abdominal pain with left upper quadrant abdominal. Although it can occur asymptomatically, the typical symptom is severe pain in the. Splenic infarct symptoms, diagnosis, treatments and causes. Ct scan is currently the preferred diagnostic test. Most commonly seen in homozygous sickle cell disease. Splenic infarction in acute infectious mononucleosis.
Forty splenic infarcts in 23 patients were examined with ultrasound us. Ruiz carazo e, munoz parra f, jimenez villares mp, et al. Unsurprisingly there is also a probable small renal infarct. Cytomegalovirus cmv is a type of herpes infection that has a characteristic feature of maintaining lifelong latency within the host cell. Conclusion splenic infarction, a cause of abdominal pain, is rarely encountered and often unnoticed. The role of ffdg petct in the evaluation of solid splenic. Splenic angiograms were performed in nine patients and seven demonstrated wedgeshaped regions of decreased perfusion corresponding to the infarction seen on. Know the causes, signs, symptoms, treatment and diagnosis of splenic infarction. We report the case of a 36yearold caucasian woman with acute cytomegalovirus infection presenting with spontaneous splenic infarcts. On follow up imaging this appeared characteristic of a splenic infarct. Splenic infarction jefferson digital commons thomas jefferson. Splenic infarcts genetic and rare diseases information.
Cmv manifestations can cover a broad spectrum from fever to as severe as pancytopenia, hepatitis, retinitis, meningoencephalitis, guillainbarre syndrome, pneumonia, and thrombosis. If you have problems viewing pdf files, download the latest version of adobe reader. Ct diagnosis of splenic infarction in blunt trauma. Infarcts were invariably multiple in cases of viral infection. Splenic infarction is the death of tissue necrosis in the spleen due to a blockage in blood flow. Cytomegalovirusassociated thrombosis has rarely been reported in the medical literature, and if so, mainly in immunocompromized patients. The infarct may occur in a segment of the spleen or in the complete spleen. 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.
Concomitant infarction of other organs was present in 12 patients. A nontraumatic splenic rupture leads to diagnosis of underlying abnormality previous article effects of perinatal mental disorders on the fetus and child a previously healthy 61yearold man was admitted to our hospital in june, 2014, with a 3 week history of lowgrade fever, general fatigue, and dyspnoea on exertion. Since then, after a meal, he has left sided pain sometimes 5 or 6 in severity. In cases of endocarditis, multiorgan infarcts were the rule. Cytomegalovirus associated splenic infarcts in a female patient with factor v leiden mutation. Diseases in which the blood clots more easily, such as sickle cell disease.
Additional symptoms include fever and chills, nausea and vomiting, pleuritic chest. Download fulltext pdf thrombocytopenia and splenic infarction article pdf available in british medical journal 16171. A nontraumatic splenic rupture leads to diagnosis of. 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. Cytomegalovirusassociated thrombosis has been extensively reported in the medical literature, mainly in immunecompromised patients. My husband had 2 splenic infarcts several months ago. Pubmed is a searchable database of medical literature and lists journal articles that discuss splenic infarcts. Get a printable copy pdf file of the complete article 286k, or click on a page image below to browse page by page. Pathogenesis, clinical manifestations, and diagnosis view in chinese. Etiology and management of splenic infarction and splenic. Research on splenic infarcts indicates that ultrasound imaging is a method that may be preferred. Separate one page or a whole set for easy conversion into independent pdf files. The diagnosis is based on clinical suspicion and imaging.
Nov 15, 2014 a nontraumatic splenic rupture leads to diagnosis of underlying abnormality previous article effects of perinatal mental disorders on the fetus and child a previously healthy 61yearold man was admitted to our hospital in june, 2014, with a 3 week history of lowgrade fever, general fatigue, and dyspnoea on exertion. On contrast enhanced ct posttraumatic splenic infarcts are seen as welldemarcated segmental wedge shape low attenuation areas with the base of the wedge towards the periphery of the splenic parenchyma. Even with occlusion of the main splenic artery, collateral flow from the short gastric. Pdf osler taught that splenic infarction presents with left upper abdominal quadrant pain, tenderness and swelling accompanied by a. A retrospective examination of files during a 10year period was conducted. Multiple case reports of thrombosis associated with cmv have been reported. The infarct may be segmental, or it may be global, involving the entire organ. Splenic infarcts themselves can be complicated by splenic abscess formation. We describe a case of splenic infarction in a patient who had paroxysmal atrial fibrillation after aortic valve replacement. A previously healthy, 38yearold caucasian obese body mass index bmi 32 man of hellenic. Spontaneous splenic infarction in an elderly cirrhotic patient with. Splenic infarction the american journal of emergency medicine. Splenic infarction splenic infarction can develop at high altitude, including mountain climbing and flying in unpressurized gaucher disease. Splenic infarction in a white man with sickle cell trait.
Diagnosis was of splenic infarcts secondary to embolisation at time of ablation, associated with subsequent infarct liquefaction with a splenic size of 16 cm figure 2. The patient was also found to be heterozygous for the factor v leiden mutation. There are a wide range of causes, including hypercoagulable states, embolic events and haematological disease. Splenic infarction refers to occlusion of the splenic vascular supply, leading to parenchymal ischemia and subsequent tissue necrosis. Additional symptoms include fever and chills, nausea and vomiting, pleuritic chest pain, and left shoulder pain kehr sign. 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. Indeed, this case is remarkable as a rare disease with an even more rare presentation. Case report splenic infarct as complication of sleeve gastrectomy. Causes of splenic infarction can be broken down into three main categories. Upper left quadrant abdominal pain is the main symptom, but the clinical presentation can be delayed or even absent in the initial stages. Ct diagnosis of splenic infarction in blunt trauma angelfire. Littoral cell angioma is a rare vascular splenic neoplasm arising from littoral cells, which line the splenic red pulp sinuses and believed to play a role in the immune response. 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.
Sickle cell trait in a white jewish family presenting as splenic infarction at high altitude. Left axial cect in a sickle cell patient demonstrates an enlarged spleen with multiple wedgeshaped acute splenic infarcts. We are reporting a case of plasmodium falciparum malaria with multiple splenic infarcts and its clinical course. Nov 28, 2018 splenic infarction refers to occlusion of the splenic vascular supply, leading to parenchymal ischemia and subsequent tissue necrosis. In case series of splenic infarction from all causes, most patients were symptomatic, yet about 2030% of them were asymptomatic. Splenic infarction is a rare complication of malaria and its clinical course remains incompletely understood. Splenic infarction two large splenic infarcts, as demonstrated on an abdominal ct scan white arrows in a 36yearold caucasian woman with acute cytomegalovirus infection. Technical considerations for minimizing the risk of splenic infarct could include dividing the sgvs as close to the. A thorough clinical examination and imaging studies. Approximately one third of splenic infarcts are clinically occult. Splenic infarction occurs as a result of tissue necrosis that develops due to parenchymal ischemia, which is a result of the interruption of arterial blood supply to the spleen.
Included were all adult patients n16 years with computed tomography ct proven diagnosis of splenic infarction. Mar 02, 2016 research on splenic infarcts indicates that ultrasound imaging is a method that may be preferred. Cytomegalovirusassociated splenic infarcts in a female. Splenic infarct in a white man with sickle cell trait. However, the association with splenic infarcts has been rarely mentioned.
Splenic infarction is a rather rare pathology most commonly associated with hematologic disorders splenic infarction typically presents on ct as a wedgeshaped region of low attenuation with the apex directed toward the splenic hilum the infarct may be segmental or involve the entire organ. Therefore,extensivedivisionofthesgvs increases the likelihood of severing these splenic branches. Splenic infarction can have a wide range of clinical presentations, from asymptomatic to fatal hemorrhage 3, 10. Aspiration of the splenic haematoma showed altered blood. Unusual causes of splenic infarction include malaria, pancreatitis, cocaine use, and splenic infarction occurring as a late complication of liver transplantation. Click on the link to view a sample search on this topic. Information for healthcare providers what are the signs and symptoms of splenic infarct. Highly tender spleen rupture with sub capsular hematoma splenic abscess splenic infarct sickling of rbc in splenic artery, embolismmural,endocardial,left atrial myxoma. Patients may be asymptomatic, although more often, patients present with abdominal pain, splenomegaly, anemia.
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