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1
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Lin JW, Chen CT, Kuo Y, Jeng MJ, How CK, Huang HH. Risk factors for mortality among patients with splenic infarction in the emergency department. J Formos Med Assoc 2025; 124:375-380. [PMID: 38763857 DOI: 10.1016/j.jfma.2024.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Revised: 04/27/2024] [Accepted: 05/14/2024] [Indexed: 05/21/2024] Open
Abstract
BACKGROUND Splenic infarction is relatively uncommon with a mortality rate ranging from 5% to 34% reported in the literature. Research that focuses on this disease, particularly regarding its mortality risk factors, is scarce. This study aimed to identify the characteristics of splenic infarction and investigate risk factors for 30-day mortality in patients diagnosed with this disease in an emergency department (ED). METHODS This retrospective cohort study utilized a computed tomography (CT) database search to identify adult patients who received their first diagnosis of splenic infarction via CT scan during ED visits at a Taiwanese medical center from January 2011 to December 2021. The study employed logistic regression analysis to identify prognostic factors for 30-day mortality. RESULTS The study involved 73 patients with a median age of 71 years. ICU admission was required for 23.3% of patients, and the average hospital stay was 14 days. The 30-day mortality rate was 23.3%. Univariate logistic regression analysis revealed several mortality risk factors, including low hemoglobin level, diabetes mellitus, uremia requiring renal replacement therapy, active malignancy, high Taiwan Triage and Acuity Scale (TTAS) level, increased qSOFA score, along with high MEWS. Multivariate logistic regression analysis identified uremia requiring renal replacement therapy, active malignancy, and high TTAS level as independent predictors. CONCLUSION For ED patients with splenic infarction, the 30-day mortality rate was 23.3%. Independent predictors of mortality included uremia requiring renal replacement therapy, active malignancy, and high triage levels.
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Affiliation(s)
- Jin-Wei Lin
- Department of Emergency Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Emergency and Critical Care Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Chung-Ting Chen
- Department of Emergency Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Institute of Health Policy and Management, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Yu Kuo
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Nuclear Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Mei-Jy Jeng
- Institute of Emergency and Critical Care Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chorng-Kuang How
- Department of Emergency Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Emergency and Critical Care Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Hsien-Hao Huang
- Department of Emergency Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Emergency and Critical Care Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
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Awad D, Khater DA, Habchy P, Helou M. Accessory splenic infarction presenting as acute abdominal pain: A case report. Int J Surg Case Rep 2025; 127:110852. [PMID: 39765154 PMCID: PMC11760800 DOI: 10.1016/j.ijscr.2025.110852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2024] [Revised: 12/30/2024] [Accepted: 01/04/2025] [Indexed: 01/17/2025] Open
Abstract
INTRODUCTION Accessory spleens are a common anatomical variant, consisting of ectopic splenic tissue present in different locations in the peritoneal cavity. Typically asymptomatic, the presence of these tissue grows to be of clinical importance when complicated by infarction, rupture, or torsion. PRESENTATION OF CASE We report the case of a 36-year-old female that presented to the Emergency Department for diffuse abdominal pain and was found to have a partially ruptured splenule secondary to a venous infarct on abdominal computed tomography scan. The patient was admitted to the hospital for pain management and further workup. Her hospital stay was uncomplicated with complete resolution of symptoms after 5 days. DISCUSSION The usually asymptomatic accessory spleen can present in case of infarction with vague symptoms like abdominal pain, nausea, or vomiting. It is triggered by conditions such hematologic disorders, embolic disorders, vascular disorders, and trauma. Oral contraceptive pills increase thrombosis risk by affecting coagulation factors, making them a potential cause of infarction. Diagnosis typically involves CT imaging, and treatment ranges from supportive care to surgical intervention. CONCLUSION Accessory spleen infarction, although rare, is a diagnosis that should be considered in the assessment of a patient presenting to the emergency with acute abdominal pain.
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Affiliation(s)
- Dana Awad
- Emergency Medicine Department, Lebanese American University Medical Center, Beirut, Lebanon.
| | - Danielle Abou Khater
- Emergency Medicine Department, Lebanese American University Medical Center, Beirut, Lebanon.
| | - Peter Habchy
- General Surgery Department, Lebanese American University Medical Center, Beirut, Lebanon.
| | - Mariana Helou
- Emergency Medicine Department, Lebanese American University Medical Center, Beirut, Lebanon.
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3
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Prohl EG, Vaidya NK. Splenic Infarction in a Patient With Sickle Cell Trait Following High-Altitude Exposure. Cureus 2025; 17:e77438. [PMID: 39949449 PMCID: PMC11824907 DOI: 10.7759/cureus.77438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2024] [Accepted: 01/11/2025] [Indexed: 02/16/2025] Open
Abstract
Sickle cell trait (SCT) is a generally asymptomatic carrier condition but clinical complications are recognized. Splenic infarction from exposure to high altitude is one complication of sickle cell trait. We report a 53-year-old man who traveled to Mammoth Lakes, California, and experienced an onset of abdominal pain approximately seven hours after arrival. In the local emergency department, the patient was diagnosed with presumed SCT using the sickle cell solubility test. Contrast-enhanced computed tomography (CECT) of the abdomen and pelvis obtained 12 hours after symptom onset was read as mild heterogenous enhancement of the spleen but without acute disease. After supportive care, the patient was discharged the next day with recommendations to descend immediately for presumed splenic syndrome. When his symptoms continued for days unabated, the patient presented to his primary care office, and repeat imaging performed 10 days later demonstrated a large splenic infarction. The patient recovered fully with supportive therapy and the diagnosis of SCT was confirmed by hemoglobin electrophoresis.
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Affiliation(s)
- Eian G Prohl
- Internal Medicine, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, USA
- Internal Medicine, David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, USA
| | - Neel K Vaidya
- Radiology, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, USA
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Chen Q, Fu Y, Li Y, Cai H, Wang X, Wu Z, Meng L, Zhang M, Chen Z, Jiang J, Cheng K, Li J, Zhang D, Cai Y, You J, Cai Y, Peng B. Interim analysis of short-term outcomes after laparoscopic spleen-preserving distal pancreatectomy with or without preservation of splenic vessels: a randomised controlled trial. Int J Surg 2025; 111:617-627. [PMID: 38954668 PMCID: PMC11745598 DOI: 10.1097/js9.0000000000001874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Accepted: 06/17/2024] [Indexed: 07/04/2024]
Abstract
BACKGROUND Laparoscopic spleen-preserving distal pancreatectomy (LSPDP) is a widely adopted surgical approach for benign and low-grade malignant neoplasms of the distal pancreas. The Kimura and Warshaw techniques represent two principal strategies, yet it still needs to be determined which one is superior. Our investigation aimed to evaluate the clinical outcomes associated with each technique. MATERIALS AND METHODS This single-center, parallel-group, patient-blinded randomized controlled trial was conducted at the West China Hospital of Sichuan University. Stratified block randomization was utilized to enroll 114 patients starting in March 2022, with an interim analysis of short-term outcomes scheduled after 45-50% of participant enrollment. Patients were randomized to receive LSPDP via either the Kimura or Warshaw technique. The primary endpoint was intraoperative blood loss, while secondary endpoints included a range of outcomes from composite outcome to quality of life, as quantified by the EQ-5D-5L. RESULTS From March 2022 to November 2023, 53 patients were randomly allocated to the Kimura ( n =25) or Warshaw ( n =28) groups for LSPDP. Baseline characteristics and postoperative outcomes were similar between the groups, such as pancreatic fistula incidence, EQ-5D-5L index scores, and delayed gastric emptying rates. Per-protocol (PP) analysis revealed that the Kimura group experienced significantly less blood loss (52.5±51.6 ml vs. 91.7±113.5 ml, P =0.007) and a reduced rate of composite outcome (23.8 vs. 56.7%, P =0.019), but incurred higher costs in the Warshaw group (¥56 227.4±¥7027.0 vs. ¥63 513.8±¥12 944.5, P =0.013). Splenic infarction rates were higher in the Warshaw group, though not statistically significant (ITT: 39.3 vs. 12.5%, P =0.058; PP: 36.7 vs. 14.3%, P =0.113), without necessitating intervention. Neither group experienced postpancreatectomy hemorrhage, 90-day mortality, or ICU admissions, and all postoperative complications were mild (Clavien-Dindo Grade CONCLUSIONS The 90-day interim analysis postoperatively indicates that both Kimura and Warshaw techniques for LSPDP are safe and viable. The Kimura technique, however, confers superior in terms of reduced intraoperative blood loss and fewer complications, alongside lower costs.
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Affiliation(s)
- Qiangxing Chen
- Division of Pancreatic Surgery, Department of General Surgery, West China Hospital, Sichuan University
- West China School of Medicine, West China Hospital, Sichuan University
- Department of Pancreatobiliary Surgery, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Yangzhi Fu
- Division of Pancreatic Surgery, Department of General Surgery, West China Hospital, Sichuan University
- West China School of Medicine, West China Hospital, Sichuan University
| | - Yongbin Li
- Division of Pancreatic Surgery, Department of General Surgery, West China Hospital, Sichuan University
- Department of Hepatopancreatobiliary Minimal Invasive Surgery, Shangjin Nanfu Hospital
| | - He Cai
- Division of Pancreatic Surgery, Department of General Surgery, West China Hospital, Sichuan University
| | - Xin Wang
- Division of Pancreatic Surgery, Department of General Surgery, West China Hospital, Sichuan University
| | - Zhong Wu
- Division of Pancreatic Surgery, Department of General Surgery, West China Hospital, Sichuan University
| | - Lingwei Meng
- Division of Pancreatic Surgery, Department of General Surgery, West China Hospital, Sichuan University
- West China School of Medicine, West China Hospital, Sichuan University
| | - Man Zhang
- Division of Pancreatic Surgery, Department of General Surgery, West China Hospital, Sichuan University
| | - Zixin Chen
- Division of Pancreatic Surgery, Department of General Surgery, West China Hospital, Sichuan University
- West China School of Medicine, West China Hospital, Sichuan University
| | - Jingwen Jiang
- Division of Pancreatic Surgery and West China Biomedical Big Data Center, West China Hospital, Sichuan University, Chengdu, China; and Med-X Center for Informatics, Sichuan University
| | - Ke Cheng
- Division of Pancreatic Surgery, Department of General Surgery, West China Hospital, Sichuan University
- Division of Liver Surgery, Department of General Surgery, West China Hospital of Sichuan University
| | - Jun Li
- Division of Pancreatic Surgery, Department of General Surgery, West China Hospital, Sichuan University
- West China School of Medicine, West China Hospital, Sichuan University
| | - Dian Zhang
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, People’s Republic of China, Guangzhou, China
| | - Yu Cai
- Division of Pancreatic Surgery, Department of General Surgery, West China Hospital, Sichuan University
| | - Jiaying You
- Division of Pancreatic Surgery, Department of General Surgery, West China Hospital, Sichuan University
| | - Yunqiang Cai
- Division of Pancreatic Surgery, Department of General Surgery, West China Hospital, Sichuan University
| | - Bing Peng
- Division of Pancreatic Surgery, Department of General Surgery, West China Hospital, Sichuan University
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Ahmed A, Khan SJ, Tariq S, Adeoshun L. Splenic Infarct: A Rare Complication of Infectious Mononucleosis in a Monospot-Negative Patient. Cureus 2024; 16:e76127. [PMID: 39835048 PMCID: PMC11744882 DOI: 10.7759/cureus.76127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/21/2024] [Indexed: 01/22/2025] Open
Abstract
Splenic infarction with infectious mononucleosis (IM) caused by Epstein-Barr Virus (EBV) has been reported as a rare complication of IM. The monospot test, often used to diagnose EBV-related IM, may produce false-negative results, especially in atypical presentations or early stages of infection. This report describes the case of a monospot-negative patient who developed splenic infarction as a complication of IM. The pathophysiology of splenic infarction in IM remains poorly understood, though it is thought to be related to splenic congestion, thrombophilia, or the direct impact of EBV on the spleen's vasculature. This case report illustrates the diagnostic challenges and clinical significance of splenic infarction in a 21-year-old female who presented with fever, jaundice, fatigue, and mild abdominal discomfort. She was found to have splenic infarcts on imaging. Her monospot test was negative. However, she was diagnosed with EBV infection on EBV viral capsid antigen (VCA) antibody testing. This case also emphasizes the importance of clinical vigilance in diagnosing and managing rare complications of IM, even in the absence of positive monospot results, and highlights the need for further investigation into the mechanisms that predispose certain individuals to splenic infarction during infectious mononucleosis.
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Affiliation(s)
- Arshia Ahmed
- Internal Medicine, Guthrie Lourdes Hospital, Binghamton, USA
| | - Salman J Khan
- Public Health, University of Massachusetts Amherst, Amherst, USA
- Internal Medicine, Guthrie Lourdes Hospital, Binghamton, USA
| | - Sara Tariq
- Internal Medicine, Guthrie Lourdes Hospital, Binghamton, USA
| | - Lela Adeoshun
- Internal Medicine, Guthrie Lourdes Hospital, Binghamton, USA
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Cantoni S, Pappalettera L, Vanzulli A, Cairoli R. Hypoplasia of the Spleen: Rare and Puzzling. Am J Med 2024; 137:e157-e158. [PMID: 38795940 DOI: 10.1016/j.amjmed.2024.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Revised: 05/06/2024] [Accepted: 05/06/2024] [Indexed: 05/28/2024]
Affiliation(s)
- Silvia Cantoni
- Department of Hematology, Niguarda Cancer Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Luca Pappalettera
- Department of Hematology, Niguarda Cancer Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Angelo Vanzulli
- Department of Radiology, Niguarda Cancer Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Roberto Cairoli
- Department of Hematology, Niguarda Cancer Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy; School of Medicine, Università degli Studi di Milano Bicocca, Milan, Italy.
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7
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Grishin E, Soudack M, Levy-Mendelovich S, Bezalel Y, Lubetsky A, Cohen O, Brutman-Barazani T, Efros O, Kenet G, Barg AA. Pediatric splenic infarction: Assessment of associated clinical conditions and outcome. Pediatr Blood Cancer 2024; 71:e30939. [PMID: 38462782 DOI: 10.1002/pbc.30939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Revised: 02/14/2024] [Accepted: 02/22/2024] [Indexed: 03/12/2024]
Abstract
Pediatric splenic infarction (SI) is rare yet clinically significant. Publications regarding this complication are mostly limited to case reports. This is a retrospective study examining SI etiology, clinical presentation, management, and outcomes among children. Twenty-two patients (median age: 7.9 years) were included, mostly with pre-existing hematological diseases. Splenomegaly (72%), thrombocytopenia, and anemia were common. Most of the patients did not receive antithrombotic therapy yet only two patients experienced recurrences. During follow up 36% of patients died, however no fatalities were attributed to thrombotic or bleeding complications.
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Affiliation(s)
- Evgeny Grishin
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Michalle Soudack
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Pediatric Imaging Unit, Sheba Medical Center, Ramat Gan, Israel
| | - Sarina Levy-Mendelovich
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- National Hemophilia Center, Coagulation Unit and Amalia Biron Research Institute of Thrombosis and Hemostasis, Sheba Medical Center, Ramat Gan, Israel
- Talpiot Sheba Leadership Program, Sheba Medical Center, Ramat Gan, Israel
| | - Yael Bezalel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Pediatric Pulmonology and National CF Center, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel-Hashomer, Israel
| | - Aharon Lubetsky
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- National Hemophilia Center, Coagulation Unit and Amalia Biron Research Institute of Thrombosis and Hemostasis, Sheba Medical Center, Ramat Gan, Israel
| | - Omri Cohen
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- National Hemophilia Center, Coagulation Unit and Amalia Biron Research Institute of Thrombosis and Hemostasis, Sheba Medical Center, Ramat Gan, Israel
| | - Tami Brutman-Barazani
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- National Hemophilia Center, Coagulation Unit and Amalia Biron Research Institute of Thrombosis and Hemostasis, Sheba Medical Center, Ramat Gan, Israel
| | - Orly Efros
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- National Hemophilia Center, Coagulation Unit and Amalia Biron Research Institute of Thrombosis and Hemostasis, Sheba Medical Center, Ramat Gan, Israel
| | - Gili Kenet
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- National Hemophilia Center, Coagulation Unit and Amalia Biron Research Institute of Thrombosis and Hemostasis, Sheba Medical Center, Ramat Gan, Israel
| | - Assaf A Barg
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- National Hemophilia Center, Coagulation Unit and Amalia Biron Research Institute of Thrombosis and Hemostasis, Sheba Medical Center, Ramat Gan, Israel
- Departmnet of Pediatric Hematology-Oncology, The Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Ramat Gan, Israel
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8
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Wyttynck A, Bismut M, Belhomme N, Perlat A, Ballerie A, Lescoat A. [The causes of splenic infarction: An almost systematic review of the literature]. Rev Med Interne 2024; 45:264-270. [PMID: 38538435 DOI: 10.1016/j.revmed.2024.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 03/05/2024] [Accepted: 03/05/2024] [Indexed: 06/07/2024]
Abstract
INTRODUCTION Splenic infarction is a rare event in clinical practice, diagnosed by CT scan. There are many causes. They often determine the treatment given. However, there is no consensus on etiological investigations. METHODS We present here an almost systematic review of the literature, based on data available on Pubmed from 1991 to 2022. Using the keywords "splenic infarct", from 1893 references, 11 cohort studies and 867 clinical cases were included in this review. Articles written in languages using alphabets other than Latin were excluded. RESULTS AND CONCLUSIONS Analysis of these various studies has enabled us to draw up a list that is intended to be as exhaustive as possible of the causes of splenic infarction. The most frequent are emboligenic heart disease, hematological malignancies, solid neoplasia and certain infections. The descriptions available in the literature were mainly based on isolated clinical cases, not always making it possible to establish a causal link with the disease described, especially as around 20% of reported cases of splenic infarction were asymptomatic and potentially of incidental discovery. Based on the findings of this literature review, we propose a protocol for the etiological assessment of splenic infarcts.
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Affiliation(s)
- A Wyttynck
- Service de médecine interne et immunologie clinique, CHU de Rennes, 16, boulevard de Bulgarie, 35203 Rennes, France.
| | - M Bismut
- Eugène Marquis, avenue de la Bataille de Flandres-Dunkerque, cs 44229, 35000 Rennes, France
| | - N Belhomme
- Service de médecine interne et immunologie clinique, CHU de Rennes, 16, boulevard de Bulgarie, 35203 Rennes, France
| | - A Perlat
- Service de médecine interne et immunologie clinique, CHU de Rennes, 16, boulevard de Bulgarie, 35203 Rennes, France
| | - A Ballerie
- Service de médecine interne et immunologie clinique, CHU de Rennes, 16, boulevard de Bulgarie, 35203 Rennes, France
| | - A Lescoat
- Service de médecine interne et immunologie clinique, CHU de Rennes, 16, boulevard de Bulgarie, 35203 Rennes, France
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Li Y, Piao YR, Han TX, Mao HW. Clinical characteristics and treatment of splenic infarction in children with systemic lupus erythematosus. World J Pediatr 2024; 20:525-531. [PMID: 37561338 DOI: 10.1007/s12519-023-00748-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 07/14/2023] [Indexed: 08/11/2023]
Affiliation(s)
- Yan Li
- Department of Immunology, Ministry of Education Key Laboratory of Major Diseases in Children, Beijing Key Laboratory for Genetics of Birth Defects, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, No. 56 Nan Li Shi Lu, Beijing, 100045, China
| | - Yu-Rong Piao
- Department of Immunology, Ministry of Education Key Laboratory of Major Diseases in Children, Beijing Key Laboratory for Genetics of Birth Defects, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, No. 56 Nan Li Shi Lu, Beijing, 100045, China
| | - Tong-Xin Han
- Department of Immunology, Ministry of Education Key Laboratory of Major Diseases in Children, Beijing Key Laboratory for Genetics of Birth Defects, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, No. 56 Nan Li Shi Lu, Beijing, 100045, China
| | - Hua-Wei Mao
- Department of Immunology, Ministry of Education Key Laboratory of Major Diseases in Children, Beijing Key Laboratory for Genetics of Birth Defects, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, No. 56 Nan Li Shi Lu, Beijing, 100045, China.
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10
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Singhal A, Suchman KI, Rhee A, Patel H, Paracha A, Agrawal V, Cohen J. Splenic Infarction Due to Epstein-Barr Virus: A Case Report and Literature Review. Cureus 2024; 16:e58414. [PMID: 38756285 PMCID: PMC11098526 DOI: 10.7759/cureus.58414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/16/2024] [Indexed: 05/18/2024] Open
Abstract
Splenic infarction is a rare and likely underdiagnosed complication of Epstein-Barr virus (EBV)-associated infectious mononucleosis (IM). Here, we describe an 18-year-old Guyanese male with persistent severe left-sided abdominal pain found to be EBV positive and have a large splenic infarct, along with a transient decrease in protein C, protein S, and antithrombin III activity levels. He was treated with supportive care and anticoagulated with heparin and apixaban. We review prior reports and perspectives on underlying pathophysiology, diagnosis, and the management of these cases, which likely do not require anticoagulation but may be considered on a per-case basis.
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Affiliation(s)
- Adit Singhal
- Internal Medicine, Northwell Health, New Hyde Park, USA
| | | | - Aaron Rhee
- Internal Medicine, Northwell Health, New Hyde Park, USA
- Internal Medicine, Zucker School of Medicine at Hofstra/Northwell, Hempstead, USA
| | - Himanshu Patel
- Internal Medicine, Northwell Health, New Hyde Park, USA
- Internal Medicine, Zucker School of Medicine at Hofstra/Northwell, Hempstead, USA
| | - Awais Paracha
- Internal Medicine, Northwell Health, New Hyde Park, USA
| | - Vedika Agrawal
- Pediatrics, Ohio State University, Nationwide Children's Hospital, Columbus, USA
| | - Jessica Cohen
- Internal Medicine, Northwell Health, New Hyde Park, USA
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11
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Wang XL, Liu JY, Wang JY, Xin Y. Splenic infarction secondary to Epstein-Barr virus-associated infectious mononucleosis in children: A case report and literature review. Asian J Surg 2023; 46:5930-5931. [PMID: 37696696 DOI: 10.1016/j.asjsur.2023.08.214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 08/30/2023] [Indexed: 09/13/2023] Open
Affiliation(s)
- Xiao-Li Wang
- Department of Pediatric, Yantai Yu Huang Ding Hospital, Yantai, 264099, China
| | - Jian-Ying Liu
- Department of Pediatric, Yantai Yu Huang Ding Hospital, Yantai, 264099, China
| | - Jian-Yong Wang
- Department of Pediatric, Yantai Yu Huang Ding Hospital, Yantai, 264099, China
| | - Yi Xin
- Department of Pediatric, Yantai Yu Huang Ding Hospital, Yantai, 264099, China.
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12
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Shi L, Wang S, Li X, Li X, Li Y, Wang Y. Acute Brucella infection associated with splenic infarction: a case report and review of the literature. Front Cell Infect Microbiol 2023; 13:1234447. [PMID: 37860068 PMCID: PMC10582943 DOI: 10.3389/fcimb.2023.1234447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Accepted: 09/12/2023] [Indexed: 10/21/2023] Open
Abstract
Brucella infection often involves multiple organ systems with non-specific clinical manifestations, and cutaneous involvement is uncommon. Splenic infarction and leukocytoclastic vasculitis also rarely occur together in the course of brucellosis infection. We report the case of a 47-year-old man with Brucella combined with splenic infarction. The patient presented with fever; large liver, spleen, and lymph nodes; muscle and joint pain; positive laboratory tests for blood cultures (Brucella abortus); and imaging suggestive of splenic infarction. After treatment with streptomycin, doxycycline, and rifampicin, the patient's clinical symptoms and splenic damage improved. Detailed history taking, correct interpretation of laboratory results, and knowledge of rare complications of human brucellosis facilitate early diagnosis and treatment of the disease.
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Affiliation(s)
| | | | | | | | | | - Yang Wang
- Center of Infectious Disease and Pathogen Biology, Department of Infectious Diseases, The First Hospital of Jilin University, Changchun, China
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13
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Wang C, Wen S, Zhou L. Splenic Infarction with Myocardial Injury in a Diabetic Patient: A Case Report. Diabetes Metab Syndr Obes 2023; 16:2929-2937. [PMID: 37771467 PMCID: PMC10522457 DOI: 10.2147/dmso.s427586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Accepted: 09/18/2023] [Indexed: 09/30/2023] Open
Abstract
Splenic infarction (SI) is an uncommon complication of type 2 diabetes (T2D). Diabetes predisposes individuals to blood vessel abnormalities, such as atherosclerosis or thrombosis, increasing the risk of vessel occlusion and subsequent tissue infarction. If the diabetic patient has other serious diseases, such as a severe pneumonia infection and acute cardiac infarction, SI incidence may go unrecognized, making it challenging for physicians to identify. This case report discussed an 80-year-old hospitalized diabetic woman with a history of chronic bronchitis and 20 years of T2D who suffered an SI. The patient was at elevated risk for thrombosis of atrial fibrillation, manifested as an embolism of the spleen characterized by a high concentration of white blood cells. This patient also demonstrated a rapid increase in cardiac biomarkers troponin I, suggesting acute myocardial infarction (AMI) and increased amylase, which could not preclude the concern about the existence of acute pancreatitis. Abdominal CT displayed the calcification of only the splenic and other arteries, and low-density shadows were observed at the center portion of the spleen. This case demonstrated the significant occurrence of thrombotic complications in various blood vessels of multiple organs in T2D patients. Thus, clinicians should be aware of the possibility of simultaneous acute vascular infarction of several organs in diabetic patients with prior vascular constriction.
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Affiliation(s)
- Congcong Wang
- Department of Endocrinology, Shanghai Pudong Hospital, Fudan University, Shanghai, 201399, People’s Republic of China
| | - Song Wen
- Department of Endocrinology, Shanghai Pudong Hospital, Fudan University, Shanghai, 201399, People’s Republic of China
| | - Ligang Zhou
- Department of Endocrinology, Shanghai Pudong Hospital, Fudan University, Shanghai, 201399, People’s Republic of China
- Shanghai Key Laboratory of Vascular Lesions Regulation and Remodeling, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, Shanghai, People’s Republic of China
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14
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Kana T, Mehjabeen S, Kawamj A, Patel N, Shamim Z. Splenic Infarction in Acute Cytomegalovirus and Epstein-Barr Virus Concomitant Infection. Cureus 2023; 15:e46235. [PMID: 37908907 PMCID: PMC10613588 DOI: 10.7759/cureus.46235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/28/2023] [Indexed: 11/02/2023] Open
Abstract
In immunocompetent individuals, cytomegalovirus (CMV) infection can range from asymptomatic to infectious mononucleosis syndrome and can cause hemolysis. However, in immunocompromised individuals, the presentation may be complicated with various life-threatening complications. CMV-associated thrombosis is commonly reported in patients who are immunocompromised, especially in transplant recipients and in HIV-positive patients. We present a case of a previously healthy 29-year-old male patient who suffered a splenic infarction. He presented with high temperature, general malaise, and left-sided abdominal pain. He was diagnosed with CMV and Epstein-Barr virus concomitant infection. Serological studies confirmed an acute CMV infection superimposed on a chronic EBV infection.
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Affiliation(s)
- Tina Kana
- Internal Medicine, Lenox Hill Hospital, New York City, USA
| | - Saraf Mehjabeen
- Internal Medicine, Touro College of Osteopathic Medicine, New York City, USA
| | - Ahmed Kawamj
- Internal Medicine, New York Medical College, Passaic, USA
| | - Nirav Patel
- Anesthesiology, Touro College of Osteopathic Medicine, Vallejo, USA
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15
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Toti JMA, Gatti B, Hunjan I, Kottanattu L, Faré PB, Renzi S, Bianchetti MG, Milani GP, Lava SAG, Camozzi P. Splenic rupture or infarction associated with Epstein-Barr virus infectious mononucleosis: a systematic literature review. Swiss Med Wkly 2023; 153:40081. [PMID: 37245117 DOI: 10.57187/smw.2023.40081] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023] Open
Abstract
BACKGROUND Epstein-Barr virus (EBV), also known as human herpesvirus 4, is one of the most common pathogenic viruses in humans. EBV mononucleosis always involves the spleen and as such it predisposes to splenic rupture, often without a trauma, and splenic infarction. Nowadays the goal of management is to preserve the spleen, thereby eliminating the risk of post-splenectomy infections. METHODS To characterise these complications and their management, we performed a systematic review (PROSPERO CRD42022370268) following PRISMA guidelines in three databases: Excerpta Medica, the United States National Library of Medicine, and Web of Science. Articles listed in Google Scholar were also considered. Eligible articles were those describing splenic rupture or infarction in subjects with Epstein-Barr virus mononucleosis. RESULTS In the literature, we found 171 articles published since 1970, documenting 186 cases with splenic rupture and 29 with infarction. Both conditions predominantly occurred in males, 60% and 70% respectively. Splenic rupture was preceded by a trauma in 17 (9.1%) cases. Approximately 80% (n = 139) of cases occurred within three weeks of the onset of mononucleosis symptoms. A correlation was found between the World Society of Emergency Surgery splenic rupture score, which was retrospectively calculated, and surgical management: splenectomy in 84% (n = 44) of cases with a severe score and in 58% (n = 70) of cases with a moderate or minor score (p = 0.001). The mortality rate of splenic rupture was 4.8% (n = 9). In splenic infarction, an underlying haematological condition was observed in 21% (n = 6) of cases. The treatment of splenic infarction was always conservative without any fatal outcomes. CONCLUSIONS Similarly to traumatic splenic rupture, splenic preservation is increasingly common in the management of mononucleosis-associated cases as well. This complication is still occasionally fatal. Splenic infarction often occurs in subjects with a pre-existing haematological condition.
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Affiliation(s)
- Johannes M A Toti
- Department of Surgery and Transplantation, University Hospital Zurich Zurich, Switzerland
| | - Beatrice Gatti
- Family medicine, Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
| | - Isabella Hunjan
- Family medicine, Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
| | - Lisa Kottanattu
- Pediatric Institute of Southern Switzerland, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
| | - Pietro B Faré
- Clinic of Hematology, Oncology Institute of Southern Switzerland, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
| | - Samuele Renzi
- Division of Hematology and Oncology, CHUL-Laval, Quebec City, Canada
- Department of Pediatrics, Laval University, Quebec City, Canada
| | - Mario G Bianchetti
- Family medicine, Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
| | - Gregorio P Milani
- Pediatric Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | - Sebastiano A G Lava
- Pediatric Cardiology Unit, Department of Pediatrics, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland
- Heart Failure and Transplantation, Department of Pediatric Cardiology, Great Ormond Street Hospital, London, United Kingdom
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16
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Mamo G, Erickson S, Komanduri K, Zayas D, Aggarwal N. Infectious Mononucleosis-Induced Splenic Infarction: Perhaps More Common in Healthy Individuals Than Previously Thought. Cureus 2023; 15:e39472. [PMID: 37378159 PMCID: PMC10292093 DOI: 10.7759/cureus.39472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/23/2023] [Indexed: 06/29/2023] Open
Abstract
Infectious mononucleosis (IM) is a clinical syndrome that presents as a triad of fever, pharyngitis, and lymphadenopathy. In most cases, it is caused by the Epstein-Barr virus (EBV), which spreads through upper respiratory secretions, particularly saliva, earning its name as the Kissing Disease. In most cases, IM is self-limiting and resolves in two to four weeks without significant sequelae following supportive care. Although rare, IM has been associated with several serious and sometimes life-threatening complications, involving almost any organ system. Splenic infarction is one rare complication of IM due to EBV infection. In the past, IM-induced splenic infarction in the setting of EBV was believed to be rare and mostly limited to patients with underlying hematologic comorbidities. However, we propose this condition to be more common and more likely to occur in individuals without significant medical history than previously suspected. We report a relatively healthy young male patient in his thirties, with no previous history of coagulopathy or complex medical conditions, who was found to have IM-induced splenic infarction.
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Affiliation(s)
- Gabriella Mamo
- Internal Medicine, HCA Florida Ocala Hospital, Ocala, USA
| | - Stephanie Erickson
- Internal Medicine, University of Central Florida College of Medicine, Orlando, USA
| | | | - Dewid Zayas
- Internal Medicine, HCA Florida Ocala Hospital, Ocala, USA
| | - Niti Aggarwal
- Internal Medicine, HCA Florida Ocala Hospital, Ocala, USA
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17
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Shrestha DB, Shtembari J, Sowunmi L, Adhikari A, Joshi T. Streptococcus agalactiae as a Primary Cause of Infective Endocarditis With Septic Emboli in an Undiagnosed Rheumatic Mitral Stenosis Patient: An Encounter in a US-Based Safety-Net Hospital. Cureus 2023; 15:e37802. [PMID: 37213989 PMCID: PMC10198664 DOI: 10.7759/cureus.37802] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 04/18/2023] [Indexed: 05/23/2023] Open
Abstract
Splenic infarct is a rare sequel of Streptococcus agalactiae infective endocarditis (IE). We report a case of a 43-year-old woman with multiple comorbidities diagnosed with a splenic infarct secondary to group B Streptococcus IE. The development of a splenic hematoma complicated the hospital course. This case highlights the less common etiology of IE and the potential complications.
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Affiliation(s)
- Dhan B Shrestha
- Department of Internal Medicine, Mount Sinai Hospital, Chicago, USA
| | - Jurgen Shtembari
- Department of Internal Medicine, Mount Sinai Hospital, Chicago, USA
| | - Leanne Sowunmi
- Department of Internal Medicine, Ross University School of Medicine, Bridgetown, BRB
| | - Aarya Adhikari
- Department of Internal Medicine, Chitwan Medical College, Bharatpur, NPL
| | - Tilak Joshi
- Department of Internal Medicine, Mount Sinai Hospital, Chicago, USA
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18
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Karaosmanoglu AD, Onder O, Kizilgoz V, Hahn PF, Kantarci M, Ozmen MN, Karcaaltincaba M, Akata D. Infarcts and ischemia in the abdomen: an imaging perspective with an emphasis on cross-sectional imaging findings. Abdom Radiol (NY) 2023; 48:2167-2195. [PMID: 36933024 PMCID: PMC10024022 DOI: 10.1007/s00261-023-03877-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 02/23/2023] [Accepted: 02/24/2023] [Indexed: 03/19/2023]
Abstract
Infarcts and ischemia of abdominal organs may present with acute abdominal pain, and early diagnosis is crucial to prevent morbidity and mortality. Unfortunately, some of these patients present in poor clinical conditions to the emergency department, and imaging specialists are crucial for optimal outcomes. Although the radiological diagnosis of abdominal infarcts is often straightforward, it is vital to use the appropriate imaging modalities and correct imaging techniques for their detection. Additionally, some non-infarct-related abdominal pathologies may mimic infarcts, cause diagnostic confusion, and result in delayed diagnosis or misdiagnosis. In this article, we aimed to outline the general imaging approach, present cross-sectional imaging findings of infarcts and ischemia in several abdominal organs, including but not limited to, liver, spleen, kidneys, adrenals, omentum, and intestinal segments with relevant vascular anatomy, discuss possible differential diagnoses and emphasize important clinical/radiological clues that may assist radiologists in the diagnostic process.
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Affiliation(s)
| | - Omer Onder
- Department of Radiology, Hacettepe University School of Medicine, 06100, Ankara, Turkey
| | - Volkan Kizilgoz
- Department of Radiology, Erzincan Binali Yıldırım University School of Medicine, 24100, Erzincan, Turkey
| | - Peter F Hahn
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA
| | - Mecit Kantarci
- Department of Radiology, Erzincan Binali Yıldırım University School of Medicine, 24100, Erzincan, Turkey
- Department of Radiology, Atatürk University School of Medicine, 25240, Erzurum, Turkey
| | - Mustafa Nasuh Ozmen
- Department of Radiology, Hacettepe University School of Medicine, 06100, Ankara, Turkey
| | | | - Deniz Akata
- Department of Radiology, Hacettepe University School of Medicine, 06100, Ankara, Turkey
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19
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Baroudi MMHD, Kamal sabra M, Abuzaid H, Alhussein H, Alkhalaila O, Habib MB. Subacute infective endocarditis presenting with an isolated splenic infarction. IDCases 2023; 32:e01752. [PMID: 37063782 PMCID: PMC10090703 DOI: 10.1016/j.idcr.2023.e01752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 03/22/2023] [Accepted: 03/28/2023] [Indexed: 03/31/2023] Open
Abstract
Background Subacute endocarditis usually presents over a period of weeks or months. Symptoms usually include low grade fever, and generalized symptoms of malaise, anorexia, weight loss. Here we present a case of subacute endocarditis presenting solely as acute left hypochondrial pain, which was found to be splenic infarct. Typical symptoms of subacute endocarditis were absent in our patient. Case report A 48-year-old Yemeni gentleman presented to the emergency department with acute and severe left hypochondrial abdominal pain for a few hours. Blood investigations revealed normal blood count differential, renal, liver function, and electrolyte levels. CT abdomen with contrast showed large focal wedge-shaped splenic lesion representing splenic infarct. Initial workup was negative for an underlying etiology. TEE showed a spherical mobile mass attached to the aortic valve with moderate to severe aortic regurgitation. Subsequently, 3 sets of blood cultures were sent and revealed growth of streptococcus viridians in all bottles. The patient received IV antibiotics as a treatment of endocarditis. Conclusion This case highlights how subacute endocarditis presented as splenic infarction, with the absence of the typical infectious symptoms. In case of splenic infarction with unclear source or etiology, it is reasonable to investigate thoroughly for infective endocarditis preferably with TEE.
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20
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Muacevic A, Adler JR, Prakash P, Hussein A, Alzghoul H, Bilal M, Oyetoran A, Iyer UG. A Rare Case of Splenic Artery Thrombosis Provoked By Medroxyprogesterone Acetate Requiring Splenectomy. Cureus 2023; 15:e33880. [PMID: 36819368 PMCID: PMC9933890 DOI: 10.7759/cureus.33880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/12/2023] [Indexed: 01/19/2023] Open
Abstract
Splenic artery thrombosis is estimated to occur in only 0.016% of hospital admissions. Hormonal contraception is known to have hypercoagulable side effects, but splenic artery thrombosis (SAT) followed by functional autosplenectomy is a very rare side effect. We report a case of a 48-year-old female with persistent SAT provoked by depot medroxyprogesterone acetate (DMPA). She initially presented with severe left lower quadrant abdominal pain, and imaging revealed an extensive thrombus in the splenic artery. She was immediately started on intravenous heparin, and her symptoms improved after a few days, at which point she was discharged on oral apixaban. Three months after discharge, the patient presented with symptoms similar to the initial presentation. Further history revealed that she received an injectable DMPA shot prior to her initial admission. Other possible causes of SAT were ruled out. On imaging, her previous thrombus had increased in size and now filled the entire splenic artery. Therefore, the patient underwent robotic splenectomy with remarkable improvement in her symptoms. This case represents a rare clinical manifestation of a hypercoagulable state induced by DMPA. We review the existing literature to explain the epidemiology, presentation, diagnosis, and treatment of SAT, and incorporate our patient's presentation into the existing literature regarding the effect of contraception in inducing thrombotic events.
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21
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Lee MW, Yeon SH, Ryu H, Song IC, Lee HJ, Yun HJ, Kim SY, Shin KS, Jo DY. Splenic Infarction in Patients with Philadelphia-negative Myeloproliferative Neoplasms. Intern Med 2022; 61:3483-3490. [PMID: 35527026 PMCID: PMC9790792 DOI: 10.2169/internalmedicine.9124-21] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Objective We retrospectively analyzed the prevalence and clinical features of splenic infarctions in patients with Philadelphia chromosome-negative myeloproliferative neoplasms (Ph- MPNs). Patients Patients diagnosed with essential thrombocythemia (ET), polycythemia vera (PV), prefibrotic/early primary myelofibrosis (pre-PMF), or PMF from January 1996 to October 2020 in Chungnam National University Hospital, Daejeon, Korea, were reviewed. Results A total of 347 patients (143 ET, 129 PV, 44 pre-PMF, and 31 PMF patients; 201 men and 146 women) with a median age of 64 (range 15-91) years old were followed up for a median of 4.7 (range 0.1-26.5) years. Fifteen (4.3%) patients exhibited splenic infarctions at the diagnosis. These were most common in PMF patients (12.9%), followed by pre-PMF (9.1%) and PV (5.4%) patients. Multifocal infarcts (60.0%) were most common, followed by solitary (33.3%) and extensive infarcts (6.7%). The cumulative incidence of thrombosis in patients with splenic infarctions tended to be higher than in those lacking infarctions (10-year incidence 46.7% vs. 21.0% in PV; p=0.215; 33.3% vs. 17.9% in pre-PMF; p=0.473) patients, but statistical significance was lacking. Palpable splenomegaly (hazard ratio 14.89; 95% confidence interval 4.00-55.35; p<0.001) was the only independent risk factor for splenic infarction. During follow-up, 5 (1.4%) patients developed splenic infarctions. Conservative treatment adequately controlled the symptoms; no serious complications were noted in any patient. Conclusion Splenic infarctions occurred most frequently in patients with PMF; it was rare in patients with ET. The clinical courses were generally mild.
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Affiliation(s)
- Myung-Won Lee
- Division of Hematology/Oncology, Department of Internal Medicine, Chungnam National University College of Medicine, Korea
| | - Sang-Hoon Yeon
- Division of Hematology/Oncology, Department of Internal Medicine, Chungnam National University College of Medicine, Korea
| | - Hyewon Ryu
- Division of Hematology/Oncology, Department of Internal Medicine, Chungnam National University College of Medicine, Korea
| | - Ik-Chan Song
- Division of Hematology/Oncology, Department of Internal Medicine, Chungnam National University College of Medicine, Korea
| | - Hyo-Jin Lee
- Division of Hematology/Oncology, Department of Internal Medicine, Chungnam National University College of Medicine, Korea
| | - Hwan-Jung Yun
- Division of Hematology/Oncology, Department of Internal Medicine, Chungnam National University College of Medicine, Korea
| | - Seon Young Kim
- Department of Laboratory Medicine, Chungnam National University College of Medicine, Korea
| | - Kyung Sook Shin
- Department of Radiology, Chungnam National University College of Medicine, Korea
| | - Deog-Yeon Jo
- Division of Hematology/Oncology, Department of Internal Medicine, Chungnam National University College of Medicine, Korea
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22
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Tokur O, Aydın S, Kantarci M. Commentary on "Gallstone associated celiac trunk thromboembolisms complicated with splenic infarction: A case report''. World J Clin Cases 2022; 10:12059-12061. [PMID: 36405298 PMCID: PMC9669843 DOI: 10.12998/wjcc.v10.i32.12059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Revised: 10/12/2022] [Accepted: 10/20/2022] [Indexed: 11/08/2022] Open
Abstract
The present letter to the editor is related to the study titled "Gallstone associated celiac trunk thromboembolisms complicated with splenic infarction: A case report''. Although gallstones are relatively common diseases, its association with thromboembolism is not fully understood. We aim to emphasize the potential mechanism of this relationship in this letter. In addition, we wanted to contribute to the causes of the spleen infarction and celiac trunk pathologies.
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Affiliation(s)
- Oguzhan Tokur
- Department of Radiology, Ankara Training and Research Hospital, Ankara 06230, Turkey
| | - Sonay Aydın
- Department of Radiology, Erzincan University Medicine Faculty, Erzincan 24100, Turkey
| | - Mecit Kantarci
- Department of Radiology, Erzincan University Medicine Faculty, Erzincan 24100, Turkey
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23
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Javaid U, Young P, Gill G, Bhargava P. Acute complete splenic infarction secondary to COVID-19 infection. Radiol Case Rep 2022; 17:1402-1406. [PMID: 35242265 PMCID: PMC8889326 DOI: 10.1016/j.radcr.2022.02.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 01/28/2022] [Accepted: 02/02/2022] [Indexed: 12/23/2022] Open
Abstract
Splenic infarction in COVID-19 patients is a rare entity with few documented cases. We report a case of symptomatic complete splenic infarction and discuss COVID-19 related thrombosis, splenic infarction, diagnostic imaging for splenic infarction, and the management. Thrombotic events related to COVID-19 have been reported in unusual locations, and our case highlights an example of one such location, the splenic artery. Contrast enhanced Computed Tomography (CT) is the standard diagnostic modality and will typically reveal foci of hypo-enhancement, peripheral and wedge-shaped. CT angiography can be performed to evaluate the arteries and diagnose thrombosis. The primary treatment is aimed at addressing the underlying cause and includes supportive care. It is important that physicians consider splenic infarction as an explanation for abdominal pain in COVID-19 patients.
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24
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Janga C, Okoyeze K, Chan V. Isolated Splenic Infarction: An Initial Manifestation of Postoperative Atrial Fibrillation. J Investig Med High Impact Case Rep 2022; 10:23247096221103384. [PMID: 35699230 PMCID: PMC9201299 DOI: 10.1177/23247096221103384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Splenic infarction is an uncommon cause of abdominal pain. In this article, we present a
case of isolated splenic infarction presenting with severe abdominal pain, nausea, and
with associated generalized weakness. Computed tomography (CT) abdomen and pelvis with
contrast revealed multiple splenic infarctions of the entire lower pole with occlusion of
the branch splenic arteries, while CT abdomen without contrast was unremarkable. Etiology
was later revealed to be thromboembolism secondary to atrial fibrillation. It was managed
with anticoagulation. To our knowledge, this is the second case of splenic infarction
presenting as an initial manifestation of atrial fibrillation (AF), reported in the
literature.
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Affiliation(s)
- Chaitra Janga
- Department of Internal Medicine, Jefferson Health–Abington, PA, USA
| | | | - Vincent Chan
- Department of Pulmonary and Critical Care, Thomas Jefferson University, Philadelphia, PA, USA
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25
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Yen CC, Wang CK, Chaou CH, Chen SY, Lin JP, Ng CJ. Anticoagulant Therapy Is Associated With Decreased Long-Term Mortality in Splenic Infarction Patients: A Multicenter Study. Front Med (Lausanne) 2021; 8:778198. [PMID: 34912831 PMCID: PMC8666632 DOI: 10.3389/fmed.2021.778198] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 11/09/2021] [Indexed: 12/31/2022] Open
Abstract
Background: Patients with splenic infarction (SI) are associated with a prothrombotic state and are vulnerable to subsequent thromboembolic complications. However, due to its rarity, there is no established treatment modality in this population. We aimed to examine the effect of anticoagulant therapy in SI patients. Methods: We performed a multicenter retrospective cohort study of 86 SI patients. Patients were categorized as anticoagulant users and anticoagulant non-users. The associations between anticoagulant therapy, all-cause mortality, thromboembolic events and bleeding events were evaluated. Results: Forty-five patients (52.3%) received anticoagulant therapy during the follow-up periods. The all-cause mortality rate was 6.86 per 100 patient-years. Anticoagulant therapy was associated with 94% improved survival (HR = 0.06; Cl 0.007–0.48; p = 0.008), while the risk factors for all-cause mortality were prior stroke (HR = 13.15; Cl 2.39–72.27; p = 0.003) and liver cirrhosis (HR = 8.71; Cl 1.29–59.01; p = 0.027). Patients with anticoagulant therapy had a higher event-free survival curve for thromboembolic complications (p = 0.03) but did not achieve a significant difference after adjustment using the Cox regression model as a time-dependent covariate (HR = 0.57; Cl 0.13–2.45; p = 0.446). There was no significant difference in the risk of bleeding events between the groups (p = 0.728). Conclusions: Anticoagulant therapy in patients with SI was associated with better survival and was not related to an increased bleeding risk.
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Affiliation(s)
- Chieh-Ching Yen
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,College of Medicine, National Yang Ming University, Taipei, Taiwan
| | - Chih-Kai Wang
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chung-Hsien Chaou
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Chang Gung Medical Education Research Center, Taoyuan, Taiwan
| | - Shou-Yen Chen
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Chang Gung Medical Education Research Center, Taoyuan, Taiwan
| | - Jhe-Ping Lin
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chip-Jin Ng
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
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26
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Prentice G, Wilson S, Coupland A, Bicknell S. Complete splenic infarction in association with COVID-19. BMJ Case Rep 2021; 14:14/12/e246274. [PMID: 34876448 PMCID: PMC8655515 DOI: 10.1136/bcr-2021-246274] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
COVID-19 predominantly affects the respiratory system. As a novel disease, understanding of its management and complications continues to grow. Herein, we present a case of almost complete splenic infarction in a patient with COVID-19 pneumonia. This case highlights the need to maintain diagnostic vigilance whilst investigating secondary complications of COVID-19. It is also important to stress the high incidence of thromboembolic complications in patients with COVID-19, which may occur anywhere in the vasculature.
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Affiliation(s)
- Graham Prentice
- Respiratory Department, Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Stephen Wilson
- Respiratory Department, Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Alexander Coupland
- Radiology Department, Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Stephen Bicknell
- Respiratory Department, Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde, Glasgow, UK
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Risk assessment and prognostic analysis of patients with splenic infarction in emergency department: a multicenter retrospective study. Sci Rep 2021; 11:21423. [PMID: 34728700 PMCID: PMC8564514 DOI: 10.1038/s41598-021-00897-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 10/07/2021] [Indexed: 01/18/2023] Open
Abstract
Splenic infarction is a thromboembolic disease that is frequently missed in acute settings. Previous reviews were rarely presented from a clinical perspective. We aimed to evaluate the clinical characteristics, risk factors with diagnostic value, and prognostic factors using large cohort data and a matched case–control study method. A retrospective medical record review of six hospitals in Taiwan from January 1, 2005, to August 31, 2020, was conducted. All patients who underwent contrast CT with confirmed the diagnosis of splenic infarction were included. Their characteristics were presented and compared to a matched control group with similar presenting characteristics. Prognostic factors were also analyzed. A total of 130 cases were included, two-thirds of whom presented with abdominal pain. Atrial fibrillation was the most common associated predisposing condition, followed by hematologic disease. A higher proportion of tachycardia, positive qSOFA score, history of hypertension or atrial fibrillation, leukocytosis, and thrombocytopenia were found in splenic infarction patients compared to their counterparts. An underlying etiology of infective endocarditis was associated with a higher proportion of ICU admission. Splenic infarction patients often presented with left upper abdominal pain and tachycardia. A history of hypertension, atrial fibrillation, a laboratory result of leukocytosis or thrombocytopenia may provide a clue for clinicians to include splenic infarction in the differential list. Among the patients diagnosed with splenic infarction, those with an underlying etiology of infectious endocarditis may be prone to deterioration or ICU admission.
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Splenic Infarcts and Splenectomy: 5 Years of Surgical Experience. Indian J Surg 2021. [DOI: 10.1007/s12262-020-02588-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Splenic infarction with aortic thrombosis in COVID-19. Am J Med Sci 2021; 362:418-423. [PMID: 34161825 PMCID: PMC8214812 DOI: 10.1016/j.amjms.2021.06.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 05/23/2021] [Accepted: 06/18/2021] [Indexed: 12/30/2022]
Abstract
Coronavirus disease 2019 (COVID-19) has been associated with an increased risk of venous and arterial thrombotic disease. Although pulmonary embolism has been the most common thrombotic complication, there have been recent reports of COVID-19-associated large-vessel ischemic stroke, acute upper- and lower-limb ischemia, as well as infarctions of the abdominal viscera, including renal, splenic, and small bowel infarctions. Here, we describe a case of splenic infarction (SI) associated with aortic thrombosis, which evolved despite the prophylactic use of low-molecular-weight heparin (LMWH), in a 60-year-old female patient with COVID-19. The patient was treated clinically with a therapeutic dose of LMWH, followed by warfarin, and eventually presented a favorable outcome. We also present a review of the literature regarding SI in patients with COVID-19.
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DAYLAN A, ŞAHİN S, AKÇİÇEK SF. Splenic infarction as a rare cause of abdominal pain in older adults: A case report. EGE TIP DERGISI 2021. [DOI: 10.19161/etd.915695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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31
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Sakran N, Zakeri R, Madhok B, Graham Y, Parmar C, Mahawar K, Arhi C, Shah K, Pouwels S. Splenic Abscess Following Sleeve Gastrectomy: A Systematic Review of Clinical Presentation and Management Methods. Obes Surg 2021; 31:2753-2761. [PMID: 33791929 DOI: 10.1007/s11695-021-05396-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 03/21/2021] [Accepted: 03/25/2021] [Indexed: 01/07/2023]
Abstract
BACKGROUND Splenic abscess is a rare complication following sleeve gastrectomy. METHODS We performed a systematic review to clarify its clinical significance, presentation, and management. PubMed, Embase, MEDLINE, Google Scholar, and the Cochrane Library were searched up to the 19th of July 2020. A total of 18 patients were included, of which 11 were female and 7 were male. The mean age was 34.1 ± 12.3 years, and the mean body mass index was 45.8 ± 7.6 kg/m2. Type 2 diabetes mellitus was reported in 11.1% of patients and hypertension in 22.2%. Fever was the most common presenting symptom seen in 17 (94.4%) patients, followed by abdominal pain in 10 (55.6%). The mean duration from surgery to presentation was 98.6 ± 132.7 days (range 10-547 days). Computed tomography was used for investigations in 17/18 (94.4%) patients. Seven patients had reported leak, three reported bleeding, and 2 reported pleural effusion. Thirteen patients had unilocular abscess. All patients were treated with antibiotics. Four patients needed total parenteral nutrition, and three were given proton pump inhibitor. In total, 11 patients needed percutaneous drainage as a part of treatment and 11 patients needed total splenectomy and 1 needed partial splenectomy. CONCLUSION Splenic abscess following sleeve gastrectomy is a rare identity. The etiology of formation of splenic abscess needs further studies. A computed tomography of the abdomen with contrast is the preferred diagnostic tool. There is no gold standard treatment for splenic abscess.
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Affiliation(s)
- Nasser Sakran
- Department of Surgery, Emek Medical Center, 21 Izhak Rabin Blvd, 1834111, Afula, Israel.
- Technion - Israel Institute of Technology, Haifa, Israel.
| | - Roxanna Zakeri
- Department of Surgery, Whittington Health NHS Trust, London, UK
| | - Brijesh Madhok
- East Midlands Bariatric and Metabolic Institute, University Hospital of Derby and Burton NHS Foundation Trust, Derby, United Kingdom
| | - Yitka Graham
- Faculty of Health Sciences and Wellbeing, University of Sunderland, Sunderland, UK
- Facultad de Psucologia, Universidad Anahuac Mexico, Mexico City, Mexico
| | - Chetan Parmar
- Department of Surgery, Whittington Health NHS Trust, London, UK
| | - Kamal Mahawar
- Faculty of Health Sciences and Wellbeing, University of Sunderland, Sunderland, UK
- Bariatric Unit, South Tyneside and Sunderland NHS Trust, Sunderland, UK
| | - Chanpreet Arhi
- Department of Surgery, University Hospital Lewisham, London, UK
| | - Kamran Shah
- Bariatric and Upper GI Department, GB Obesitas Skaane, Malmö, Sweden
| | - Sjaak Pouwels
- Department of Intensive Care Medicine, Elisabeth-Tweesteden Hospital, Tilburg, the Netherlands
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Infectious Mononucleosis Complicated with Bilateral Peritonsillar Abscess and Splenic Infarction. Case Rep Infect Dis 2021; 2021:6623834. [PMID: 33777464 PMCID: PMC7979303 DOI: 10.1155/2021/6623834] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 02/27/2021] [Accepted: 03/06/2021] [Indexed: 01/20/2023] Open
Abstract
Infectious mononucleosis (IM) due to Epstein–Barr virus (EBV) infection is usually self-limited. It presents with fever, pharyngitis, fatigue, and cervical lymph node enlargement. It is common among adolescents and young adults. Although most patients recovered without any sequelae, rare complications have been reported. We described a 28-year-old man with fever, sore throat, dysphagia, and a positive IgM viral capsid Ag (VCA Ag) for EBV infection. He was admitted and received dexamethasone. He developed bilateral peritonsillar abscess (PTA) and splenic infarction, rare complications of acute EBV infection, two days after discharge. Although early reports noted PTA might occur following dexamethasone administration, recently, no obvious evidence supports it. However, high erythrocyte sedimentation rate level in our patient might indicate bacterial superinfection, which could exacerbate with dexamethasone administration. Several mechanisms such as transient hypercoagulable state and insufficient blood supply due to splenomegaly were proposed for splenic infarction due to EBV infection. Since our patient remained asymptomatic during the disease, IM-associated splenic complications, including splenic infarction, should be kept in mind. Our patient underwent bilateral tonsillectomy and received conservative management for the splenic infarction. These two rare complications of acute EBV infection have not been reported simultaneously yet.
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Clinical characteristics and outcomes of splenic infarction in cancer patients: a retrospective, single center report of 206 cases. J Thromb Thrombolysis 2021; 52:854-862. [PMID: 33765243 DOI: 10.1007/s11239-021-02428-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/13/2021] [Indexed: 10/21/2022]
Abstract
Cancer patients have a high risk of thromboembolic events including splenic infarct (SI). However, risk factors for SI in cancer patients are poorly understood, and the utility of systemic anticoagulation in such patients is uncertain. We performed a retrospective cohort study of all cancer patients with SI treated at Yale New Haven Hospital from 2008 to 2017. Central review of radiology imaging was performed to confirm the diagnosis of SI. Baseline differences in variables among patients with and without recurrent SI were compared using Fisher's exact test, Pearson's χ2 test, and t-test. Multivariable regression models were conducted to identify factors associated with recurrent SI. Of 206 patients with cancer and SI, 42 had a prior venous thromboembolic event, while 29 had atrial fibrillation/flutter. At a median follow-up of 11.4 months (range: 0-142.3 months), 152 patients underwent follow-up imaging, with only 6 having recurrent SI. The use of anticoagulation after initial SI was associated with a nonsignificant increase in recurrent SI (p = 0.054) and was not associated with development of venous thromboembolism after SI (p = 0.414). In bivariate analyses, the risk of recurrent SI showed a significant association with lower platelet counts (p < 0.001) and with atrial fibrillation/flutter (p = 0.036). In a multivariable logistic regression model, no variables were identified that were associated with a higher risk of recurrent SI. SI in cancer patients is typically an isolated event with low recurrence risk. Anticoagulation use should be guided by other thromboembolic risk factors.
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34
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Gonzalez L, Shapiro AF, Tafur A, Plaza-Meneses C, Sabando B. Splenic Infarct Secondary to High Altitude Exposure in Sickle Cell Trait Patients: A Case Series. Cureus 2020; 12:e9815. [PMID: 32821639 PMCID: PMC7431312 DOI: 10.7759/cureus.9815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
The sickle cell trait is considered a benign entity that generally does not show clinical manifestations. However, some complications have been described under certain conditions, such as a decrease in oxygen level, dehydration, and strenuous physical efforts. Among them, splenic infarct is a rare complication that presents as left upper abdominal pain in a situation of stress such as high altitude exposure. We present two cases of splenic infarcts in patients with undiagnosed sickle cell trait who showed to our institution with severe abdominal pain after coming from high altitude cities.
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Affiliation(s)
- Luis Gonzalez
- Medicine, Nassau University Medical Center, East Meadow, USA
| | | | | | | | - Brenner Sabando
- Hematology, Hospital Luis Vernaza/Universidad Espíritu Santo (UEES), Guayaquil, ECU
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35
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Brett AS, Azizzadeh N, Miller EM, Collins RJ, Seegars MB, Marcus MA. Assessment of Clinical Conditions Associated With Splenic Infarction in Adult Patients. JAMA Intern Med 2020; 180:1125-1128. [PMID: 32658244 PMCID: PMC7358974 DOI: 10.1001/jamainternmed.2020.2168] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
This case series examines the clinical conditions associated with splenic infarction of adult patients between 2010 and 2015 from computed tomographic imaging scans.
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Affiliation(s)
- Allan S Brett
- Department of Medicine, University of South Carolina School of Medicine, Columbia
| | - Neda Azizzadeh
- Department of Medicine, University of South Carolina School of Medicine, Columbia
| | - Emily M Miller
- Department of Medicine, University of South Carolina School of Medicine, Columbia.,Now with Division of Hematology/Oncology, University of Tennessee Health Science Center, Memphis
| | - Robert J Collins
- Department of Medicine, University of South Carolina School of Medicine, Columbia.,Now with South Carolina Oncology Associates, Columbia
| | - Mary B Seegars
- Department of Medicine, University of South Carolina School of Medicine, Columbia.,Now with Division of Hematology/Oncology, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Matthew A Marcus
- Department of Radiology, University of South Carolina School of Medicine, Columbia
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36
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Thida AM, Ilonzo I, Gohari P. Multiple splenic infarcts: unusual presentation of hereditary spherocytosis associated with acute Epstein-Barr virus infection. BMJ Case Rep 2020; 13:13/7/e235131. [PMID: 32665280 DOI: 10.1136/bcr-2020-235131] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A 19-year-old African American woman presented to the emergency department with a history of left upper quadrant pain for a week, associated with nausea, malaise, loss of appetite, subjective fevers and chills. Her family history is significant for thalassemia in her maternal aunt, and hereditary spherocytosis in her brother, sister and cousin. A contrast-enhanced CT scan of the abdomen and pelvis revealed massive splenomegaly and multiple splenic infarcts. On the second day of admission, she developed a fever of 103°F. Further evaluation revealed acute Epstein-Barr virus (EBV) infection and hereditary spherocytosis. Her condition improved after 4 days on piperacillin/tazobactam, intravenous fluids, analgesics and antipyretics. Our case report describes a thorough clinical evaluation of a patient with fever, anaemia, massive splenomegaly and multiple splenic infarcts. It highlights the need for careful interpretation of multiple positive IgM results on viral serological testing that often accompanies acute EBV infections.
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Affiliation(s)
- Aye Mon Thida
- Department of Medicine, Woodhull Medical and Mental Health Center, Brooklyn, New York, USA
| | - Ifeanyi Ilonzo
- Department of Medicine, Woodhull Medical and Mental Health Center, Brooklyn, New York, USA
| | - Pouyan Gohari
- Hematology and Oncology Department, Woodhull Medical and Mental Health Center, Brooklyn, New York, USA
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37
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Sánchez-Pardo S, Ochoa-Díaz A. Infarto esplénico asociado a infección por citomegalovirus, primer reporte de caso en Colombia. INFECTIO 2020. [DOI: 10.22354/in.v24i4.887] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Introducción: El infarto esplénico ocurre cuando la arteria esplénica o alguna de sus ramas quedan ocluidas, ya sea por émbolos distantes o por trombosis in situ. Dentro de la literatura mundial hay muy pocos casos documentados de infarto esplénico asociado a infección por Citomegalovirus, por lo que este podría considerarse el primero en Colombia. Presentación del Caso: Se trata de una paciente femenina de 53 años quien fue atendida en una institución de tercer nivel de la Ciudad de Bogotá, Colombia, por cuadro de dolor abdominal, a quien se le realizó una tomografía abdominal contrastada que demostró en el bazo una lesión hipodensa en cuña correspondiente con infarto esplénico por lo cual se realizaron estudios complementarios evidenciando como único dato positivo la positividad de la IgM para Citomegalovirus, descartándose eventos de h ipercoagulabilidad. Discusión: El infarto esplénico es una condición infrecuente que normalmente se presenta con síntomas variables e inespecíficos, dentro de las enfermedades infecciosas que corresponden con aproximadamente el 30% de los diagnósticos de Infarto esplénico, la infección por Citomegalovirus únicamente ha sido reportada en muy pocos casos. Se presenta el caso de una mujer joven con infarto esplénico como diagnóstico final de dolor abdominal en quien se descartaron causas de hipercoagulabilidad y se confirma la infección aguda por Citomegalovirus, lo cual se ha descrito muy poco en la literatura y puede considerarse el primer caso reportado en Colombia.
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38
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Weber E, Lega JC. Response to: Paradoxical embolism as a cause of renal and/or splenic infarction. QJM 2020; 113:444. [PMID: 31681947 DOI: 10.1093/qjmed/hcz286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- E Weber
- Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Service de Médecine Interne et Médecine Vasculaire, F-69310 Pierre-Bénite, France
| | - J C Lega
- Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Service de Médecine Interne et Médecine Vasculaire, F-69310 Pierre-Bénite, France
- Univ Lyon, UMR 5558, Laboratoire de Biométrie et Biologie Evolutive, CNRS, Claude Bernard University Lyon, F-69100 Lyon, France
- Groupe d'Etude Multidisciplinaire des Maladies Thrombotiques (GEMMAT), Hospices Civils de Lyon, F-69003 Lyon, France
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39
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Le Borgne P, Brunhuber C, Bilbault P. Woman with sore throat, fever and abdominal pain. Eur J Intern Med 2020; 76:89-90. [PMID: 32409205 DOI: 10.1016/j.ejim.2020.04.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 04/20/2020] [Indexed: 11/24/2022]
Affiliation(s)
- Pierrick Le Borgne
- Emergency Department, Strasbourg University Hospital, Hautepierre Hospital, 1 Avenue Molière, 67200 Strasbourg, France; INSERM (French National Institute of Health and Medical Research), UMR 1260, Regenerative NanoMedicine (RNM), Fédération de Médecine Translationnelle (FMTS), University of Strasbourg, France
| | | | - Pascal Bilbault
- Emergency Department, Strasbourg University Hospital, Hautepierre Hospital, 1 Avenue Molière, 67200 Strasbourg, France; INSERM (French National Institute of Health and Medical Research), UMR 1260, Regenerative NanoMedicine (RNM), Fédération de Médecine Translationnelle (FMTS), University of Strasbourg, France
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40
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Weber E, Grangeon F, Reynaud Q, Hot A, Sève P, Jardel S, Tazarourte K, Fouque D, Juillard L, Salles G, Grange C, Durieu I, Rousset P, Lega JC. Acute renal and splenic infarctions: a review. QJM 2020; 113:186-193. [PMID: 31593227 DOI: 10.1093/qjmed/hcz252] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 09/20/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Renal and splenic infarctions are close entities, with few data concerning their clinical, biological and radiological features. AIM The aim of this study was to compare the clinical presentations, etiologies and outcomes of acute renal infarctions (RI) and splenic infarctions (SI). DESIGN A retrospective multicentric cohort study included patients of the 6 university hospitals in Lyon with RI, SI, or associated RI-SI infarctions was conducted. METHODS All consecutive cases diagnosed by CT imaging, between January 2013 and October 2016, were included. The exclusion criteria were causes of infarction that did not require additional investigations. RESULTS A total of 161 patients were selected for analysis: 34 patients with RI, 104 patients with SI and 23 patients with both RI-SI. Mean ± SD age of patients was 63.2 ± 16.6 years; 59.6% were male. Only 5/161 (3.1%) were healthy prior to the event. The main symptoms were diffuse abdominal pain (26.4%), followed by nausea/vomiting (18.3%) and fever (16.4%).The causes of RI or SI varied significantly within the three groups. Hypercoagulable state was associated with SI, and embolic disease and arterial injury were associated with RI. Extensive (i.e.>2/3 of organ volume) (OR 6.22, 95%CI 2.0119.22) and bilateral infarctions (OR 15.05, 95%CI 1.79-126.78) were significantly associated with hemodynamic shocks. The survival at 1 month follow-up did not significantly differ between the three groups. CONCLUSION Acute RI and SI are heterogenous entities in regards to their clinical presentation, etiology, associated venous or arterial thrombosis, but prognoses were not different at short term follow-up.
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Affiliation(s)
- E Weber
- From the Service de médecine interne et médecine vasculaire, Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, F-69310 Pierre-Bénite
| | - F Grangeon
- Service de radiologie, Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, F-69310 Pierre-Bénite
- Univ Lyon, 143 Boulevard du 11 Novembre 1918, 69100 Villeurbanne
| | - Q Reynaud
- From the Service de médecine interne et médecine vasculaire, Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, F-69310 Pierre-Bénite
- Univ Lyon, Health Services and Performance Research EA7425, Claude Bernard University Lyon, F-69003 Lyon
| | - A Hot
- Univ Lyon, 143 Boulevard du 11 Novembre 1918, 69100 Villeurbanne
- Service de médecine interne et médecine vasculaire, Hospices Civils de Lyon, Hôpital Edouard Herriot, F-69003 Lyon
| | - P Sève
- Univ Lyon, 143 Boulevard du 11 Novembre 1918, 69100 Villeurbanne
- Service de médecine interne, Hospices Civils de Lyon, Hôpital de la Croix Rousse, F-69004 Lyon
| | - S Jardel
- From the Service de médecine interne et médecine vasculaire, Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, F-69310 Pierre-Bénite
- Univ Lyon, 143 Boulevard du 11 Novembre 1918, 69100 Villeurbanne
| | - K Tazarourte
- Service d'accueil des Urgences, Hospices Civils de Lyon, Hôpital Edouard Herriot, F-69003 Lyon
| | - D Fouque
- Service de Néphrologie, Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, F-69310 Pierre-Bénite
| | - L Juillard
- Service de Néphrologie, Hospices Civils de Lyon, Hôpital Edouard Herriot, F-69310 Lyon
| | - G Salles
- Service d'Hématologie, Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, F-69310 Pierre-Bénite
| | - C Grange
- From the Service de médecine interne et médecine vasculaire, Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, F-69310 Pierre-Bénite
- Groupe d'Etude Multidisciplinaire des Maladies Thrombotiques (GEMMAT), Hospices Civils de Lyon, Lyon
| | - I Durieu
- From the Service de médecine interne et médecine vasculaire, Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, F-69310 Pierre-Bénite
- Univ Lyon, 143 Boulevard du 11 Novembre 1918, 69100 Villeurbanne
- Univ Lyon, Health Services and Performance Research EA7425, Claude Bernard University Lyon, F-69003 Lyon
| | - P Rousset
- Service de radiologie, Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, F-69310 Pierre-Bénite
- Univ Lyon, 143 Boulevard du 11 Novembre 1918, 69100 Villeurbanne
| | - J C Lega
- From the Service de médecine interne et médecine vasculaire, Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, F-69310 Pierre-Bénite
- Univ Lyon, 143 Boulevard du 11 Novembre 1918, 69100 Villeurbanne
- Groupe d'Etude Multidisciplinaire des Maladies Thrombotiques (GEMMAT), Hospices Civils de Lyon, Lyon
- Univ Lyon, UMR 5558, Laboratoire de Biométrie et Biologie Evolutive, CNRS, Claude Bernard University, F-69003 Lyon, France
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Safavi-Naeini P, Rasekh A. Thromboembolism in Atrial Fibrillation: Role of the Left Atrial Appendage. Card Electrophysiol Clin 2019; 12:13-20. [PMID: 32067643 DOI: 10.1016/j.ccep.2019.11.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Atrial fibrillation (AF) is the most common arrhythmia. Patients with AF have a higher risk for thromboembolism than individuals without AF. The left atrial appendage (LAA) is the main source of thromboembolism because of its anatomic, mechanical, and electrophysiologic properties, and accounts for more than 90% of thrombus formation in patients with AF. Advancement in imaging expands knowledge about anatomic and physiologic characteristics of LAA. The risk of thromboembolism events in patients with AF depends on clinical comorbidities and structural and physiologic parameters of atria, especially LAA. This article discusses AF-related thromboembolic events and the role of the LAA.
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Affiliation(s)
- Payam Safavi-Naeini
- Electrophysiology Clinical Research and Innovation, Texas Heart Institute, Houston, TX, USA
| | - Abdi Rasekh
- Cardiology, Baylor College of Medicine, 6624 Fannin Street Suite 2480, Houston, TX 77030, USA; Cardiology, Texas Heart Institute, Houston, TX, USA.
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García-Jiménez ML, Gómez-Pasantes D, Castro-Diez L, Rivas-Polo JI, Gómez-Gutiérrez M. Celiac trunk thrombosis as a presentation of Takayasu arteritis. Cir Esp 2019; 98:241-243. [PMID: 31753284 DOI: 10.1016/j.ciresp.2019.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 03/19/2019] [Accepted: 07/15/2019] [Indexed: 10/25/2022]
Affiliation(s)
- María Lourdes García-Jiménez
- Servicio de Cirugía General y del Aparato Digestivo, Complejo Hospitalario Universitario A Coruña, A Coruña, España.
| | - Dora Gómez-Pasantes
- Servicio de Cirugía General y del Aparato Digestivo, Complejo Hospitalario Universitario A Coruña, A Coruña, España
| | - Laura Castro-Diez
- Servicio de Cirugía General y del Aparato Digestivo, Complejo Hospitalario Universitario A Coruña, A Coruña, España
| | - Jose Ignacio Rivas-Polo
- Servicio de Cirugía General y del Aparato Digestivo, Complejo Hospitalario Universitario A Coruña, A Coruña, España
| | - Manuel Gómez-Gutiérrez
- Servicio de Cirugía General y del Aparato Digestivo, Complejo Hospitalario Universitario A Coruña, A Coruña, España
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Molina AL, Smola C, Wu CL, Hofto ME. Splenic infarction from vascular torsion in a child with normal splenic anatomy. BMJ Case Rep 2019; 12:12/5/e228425. [PMID: 31092484 DOI: 10.1136/bcr-2018-228425] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
This is a case of an 8-year-old, Caucasian boy with a complex prior medical history who presented with worsening, acute, left-sided abdominal pain and fever after empiric treatment for a urinary tract infection. Repeat urinalysis was negative for infection. A renal ultrasound assessing for occult perinephric abscess or nephronia revealed normal kidneys but found a tubular structure adjacent to the left kidney. A CT scan further revealed a splenic infarction secondary to torsion. He had a surgical evaluation but was treated empirically with piperacillin/tazobactam for 10 days due to concern for infectious complications following splenic infarction. He had complete resolution of his pain and symptoms. He received routine vaccines for asplenia prior to being discharged home without any further sequelae.
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Affiliation(s)
- Adolfo L Molina
- Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Cassi Smola
- Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Chang L Wu
- Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Meghan E Hofto
- Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama, USA
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Splenic Infarction in Acute Cytomegalovirus and Human Parvovirus Concomitant Infection. Case Rep Infect Dis 2019; 2018:7027656. [PMID: 30631613 PMCID: PMC6304844 DOI: 10.1155/2018/7027656] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 11/14/2018] [Indexed: 11/17/2022] Open
Abstract
We present a case report of a 35-year-old woman who had splenic infarction. She had persistent high fever, systemic joint pain, and abnormal liver function. She was diagnosed with cytomegalovirus and human parvovirus B19 concomitant infection. Her coagulopathy test revealed no abnormal results. She was treated with intravenous ganciclovir for 13 days; consequently, her splenic infarction improved after 7 weeks. As per our knowledge, this is the first case of cytomegalovirus and parvovirus B19 coinfection complicated by splenic infarction. Cytomegalovirus and parvovirus B19 may induce a hypercoagulation state during the acute phase.
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Nassour F, Schoucair NM, Tranchart H, Maitre S, Dagher I. Delayed Intra Splenic Abscess: a Specific Complication Following Laparoscopic Sleeve Gastrectomy. Obes Surg 2018; 28:589-593. [PMID: 29248980 DOI: 10.1007/s11695-017-3069-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Delayed intra splenic abscess after laparoscopic sleeve gastrectomy (LSG) is a very rare complication with poor manifestations. METHODS We present three cases of delayed intrasplenic abscess which were managed in our departmentof minimal invasive surgery. DISCUSSION Splenic abscess may occur in the early post-operative period following LSG; it is usually an extra splenic event after the gastric leak or an infected hematoma. In our cases, two patients had an asymptomatic ischemic demarcation in the upper part of the spleen. This underlines the possible role of ischemia as a factor in abscess formation of late intrasplenic abscesses that enhanced by a state of transient immune suppression. CONCLUSION Intrasplenic abscess complicating laparoscopic sleeve gastrectomy is different from early extra splenic abscesses. The exact causes are still unclear; the role of partial splenic ischemia has to be rolled out.
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Affiliation(s)
- Fajer Nassour
- Department of Minimally Invasive Digestive Surgery, Antoine Beclere Hospital, AP-HP, 92140, Clamart, France
| | - Naim Michel Schoucair
- Department of Minimally Invasive Digestive Surgery, Antoine Beclere Hospital, AP-HP, 92140, Clamart, France
| | - Hadrien Tranchart
- Department of Minimally Invasive Digestive Surgery, Antoine Beclere Hospital, AP-HP, 92140, Clamart, France.,Paris-Sud University, 91405, Orsay, France
| | - Sophie Maitre
- Department of Radiology, Antoine Beclere Hospital, AP-HP, 92140, Clamart, France.,Paris-Sud University, 91405, Orsay, France
| | - Ibrahim Dagher
- Department of Minimally Invasive Digestive Surgery, Antoine Beclere Hospital, AP-HP, 92140, Clamart, France. .,Paris-Sud University, 91405, Orsay, France. .,Department of Minimally Invasive Digestive Surgery, Antoine Beclere Hospital, 157 rue de la Porte de Trivaux, 92141, Clamart cedex, France.
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García-Vázquez J, Plácido Paias R, Portillo Márquez M. Infarto esplénico debido a una infección común. Enferm Infecc Microbiol Clin 2018; 36:593-595. [DOI: 10.1016/j.eimc.2017.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Revised: 08/24/2017] [Accepted: 09/04/2017] [Indexed: 11/15/2022]
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O'Donnell M, Shatzel JJ, Olson SR, Daughety MM, Nguyen KP, Hum J, DeLoughery TG. Arterial thrombosis in unusual sites: A practical review. Eur J Haematol 2018; 101:728-736. [PMID: 30129979 DOI: 10.1111/ejh.13165] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Revised: 08/13/2018] [Accepted: 08/14/2018] [Indexed: 12/19/2022]
Abstract
While cardiovascular disease is common, occasionally hematologists and other practitioners will encounter patients with arterial thrombosis/infarction in unusual sites, without clear cause or obvious diagnostic and treatment paradigms. Contrary to the more commonly encountered cerebrovascular accident and cardiovascular disorders, the various infarctions outlined in this review have unique presentations, pathophysiology, workup, and treatments that all hematologists should be aware of. This review outlines the current literature on arterial thrombosis, with consideration given to anatomic sources and hypercoagulable associations, while focusing on the epidemiology, pathophysiology, provoking factors, and current recommended treatments for intracardiac thrombus, primary aortic mural thrombus, visceral infarctions, and cryptogenic limb ischemia to provide a useful and practical review for the practitioner.
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Affiliation(s)
- Matthew O'Donnell
- Division of Hematology-Oncology, Oregon Health & Science University, Portland, Oregon
| | - Joseph J Shatzel
- Division of Hematology-Oncology, Oregon Health & Science University, Portland, Oregon.,Biomedical Engineering, Oregon Health & Science University, Portland, Oregon
| | - Sven R Olson
- Division of Hematology-Oncology, Oregon Health & Science University, Portland, Oregon
| | - Molly M Daughety
- Division of Hematology-Oncology, Oregon Health & Science University, Portland, Oregon
| | - Khanh P Nguyen
- Division of Vascular Surgery, Oregon Health & Science University, Portland, Oregon
| | - Justine Hum
- Division of Gastroenterology, Oregon Health & Science University, Portland, Oregon
| | - Thomas G DeLoughery
- Division of Hematology-Oncology, Oregon Health & Science University, Portland, Oregon
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Williams J, Ima S, Milrod C, Krishnamurthy M. Left lower quadrant pain: an unlikely diagnosis in a case of acute abdomen. J Community Hosp Intern Med Perspect 2018; 8:296-299. [PMID: 30357010 PMCID: PMC6197027 DOI: 10.1080/20009666.2018.1517578] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Accepted: 08/24/2018] [Indexed: 12/15/2022] Open
Abstract
Splenic infarct is an incredibly rare diagnosis for abdominal pain. One study involving two hospitals over ten years describes only 0.0037% of all hospital admissions presenting with splenic infarction. Our report describes a case of massive splenomegaly causing pain in a different location compared to the normal anatomical location of the spleen with an unexpected cause, lymphoma. High clinical suspicion for lymphoma as a cause of splenic infarction is critical because this disease can otherwise be clinically silent. This case emphasizes the importance of a thorough clinical workup and persistence in diagnostic pursuit.
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Affiliation(s)
| | - Shumona Ima
- Department of Medicine, Easton Hospital, Easton, PA, USA
| | - Charles Milrod
- College of Medicine, Drexel University, Philadelphia, PA, USA
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Jung YJ, Seo HS, Lee HH, Kim JH, Song KY, Choi MH, Park CH. Splenic Infarction as a Delayed Febrile Complication Following Radical Gastrectomy for Gastric Cancer Patients: Computed Tomography-Based Analysis. World J Surg 2018; 42:1826-1832. [PMID: 29270657 DOI: 10.1007/s00268-017-4401-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND The aim of this study was to evaluate the incidence and clinical characteristics of splenic infarction (SI) in gastric cancer patients who have undergone gastrectomy. METHODS For this study, the medical records of 1084 patients were reviewed and 877 patients were ultimately enrolled. The times of symptom onset, diagnosis of SI, and complete resolution on CT were calculated from the day of the operation. Based on the wedge shape of the SI in all cases, the total volume of the SI was measured based on that of a corn kernel. RESULTS Thirty-six patients (4.10%) were diagnosed with SI after gastrectomy; four of these patients (0.45%) developed complications associated with the SI. Total gastrectomy and extended lymph node dissection were risk factors for development of SI. Patients with complications exhibited inflammatory signs between 7 and 10 days after surgery. The mean volume of the SI was 4025.69 mm3. The mean time to complete resolution on the CT scan was 327 days postoperatively. In 30 cases, small branched arteries from the splenic artery that could have caused the SI were retrospectively detected on the preoperative CT scans. CONCLUSION Although the incidence of the SI was low, large volume of the SI is associated with complication development. Measuring the infarction volume via a CT scan may be useful to decide on the treatment strategy. Preoperative 3-D reconstruction of the splenic artery tributaries may help reduce the risk of inadvertent SI.
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Affiliation(s)
- Yoon Ju Jung
- Division of Gastrointestinal Surgery, Department of Surgery, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea
| | - Ho Seok Seo
- Division of Gastrointestinal Surgery, Department of Surgery, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea
| | - Han Hong Lee
- Division of Gastrointestinal Surgery, Department of Surgery, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea
| | - Ji Hyun Kim
- Division of Gastrointestinal Surgery, Department of Surgery, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea
| | - Kyo Young Song
- Division of Gastrointestinal Surgery, Department of Surgery, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea
| | - Moon Hyung Choi
- Department of Radiology, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea
| | - Cho Hyun Park
- Division of Gastrointestinal Surgery, Department of Surgery, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea.
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Wand O, Tayer-Shifman OE, Khoury S, Hershko AY. A practical approach to infarction of the spleen as a rare manifestation of multiple common diseases. Ann Med 2018; 50:494-500. [PMID: 29929401 DOI: 10.1080/07853890.2018.1492148] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
INTRODUCTION There are insufficient data on the aetiologic factors underlying splenic infarction (SI). Therefore, there is no consensus regarding the appropriate diagnostic approach. METHODS We conducted a retrospective analysis of all patients admitted with SI from January 2004 to December 2014. Medical records were screened for the clinical presentation, underlying causes, associated medical conditions and methods of patient evaluation. RESULTS We found 89 subjects with 90 episodes of SI. Presentation of SI was characterized by abdominal, flank and chest pain (82.2%, 18.9%, 7.8%, respectively); leukocytosis (in 67% of tested subjects); elevated LDH (72%), CRP (97.5%) and D-Dimer (100%). The main underlying mechanisms were cardioembolic (54.4%), vascular (20%), haematologic disorders (15.6%) and multiple causes (21.1%). Atrial fibrillation and atherosclerosis were common in older patients (age > 70 years) while antiphospholipid syndrome occurred exclusively in younger individuals. SI was the presentation of previously unknown medical conditions in 38% of patients. Abdominal CT, ECG, echocardiography and blood cultures demonstrated the highest diagnostic yield. CONCLUSIONS Contributing factors are identified in the majority of SI patients. We recommend CT, ECG, echocardiography and blood cultures in all cases. Atrial fibrillation should be sought in older patients, while APLS and haematologic disorders should be suspected in younger ones. KEY MESSAGES There is no consensus regarding the diagnostic approach and management of splenic infarction. Cardiovascular disease and atrial fibrillation are the main causes for SI in elderly subjects while hematological, infectious and other causes are more prevalent in younger ones. Our data strongly suggests a high diagnostic yield for CT scan, ECG, blood culture and echocardiogram in every patient with SI.
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Affiliation(s)
- Ori Wand
- a Department of Internal Medicine B , Meir Medical Center , Kfar Saba , Israel.,b Sackler School of Medicine , Tel Aviv University , Tel-Aviv , Israel
| | | | - Shafik Khoury
- a Department of Internal Medicine B , Meir Medical Center , Kfar Saba , Israel
| | - Alon Y Hershko
- a Department of Internal Medicine B , Meir Medical Center , Kfar Saba , Israel.,b Sackler School of Medicine , Tel Aviv University , Tel-Aviv , Israel.,c Department of Internal Medicine , Hadassah Medical Center , Jerusalem , Israel
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