splenic infarction

Splenic infarction is a condition in which the blood flow supply to the spleen is compromised, leading to partial or complete tissue death due to oxygen shortage [1]. This occurs when the splenic artery or one of its branches are occluded, for example by a blood clot [2].

The spleen is a vital organ that filters and removes aging blood products and aids in immunity against encapsulated bacterial organisms [3][9]. When the blood supply to the spleen is blocked, it can cause tissue ischemia and eventual necrosis [4].

Splenic infarction may be caused by arterial or venous occlusion, and can result from a variety of potential pathologies, including embolization, local thrombosis, or arterial dissection [5][13]. In some cases, the infarct may be small and localized, while in others it may affect the entire spleen [12].

Symptoms of splenic infarction may include acute pain and tenderness in the left upper quadrant or flank area [7], and can be a result of ischemia to the spleen [8]. In many cases, identification of the cause of infarction is crucial for management.

The appearance of splenic infarction on imaging studies depends on the timing of imaging and the size of the infarct. While ultrasound and CT scans are sensitive to the diagnosis in established cases, CT with contrast may be the modality of choice if the diagnosis is suspected in the hyperacute setting [10].

Risk factors for developing splenic infarction include smoking, which damages blood vessels and increases the risk of blood clots [11]. Underlying disorders such as blood diseases, blood clotting disorders, and clots that travel from other parts of the body can also contribute to development of a splenic infarction [12].

References: [1] Context 1 [2] Context 3 [3] Context 9 [4] Context 9 [5] Context 13 [7] Context 11 [8] Context 8 [9] Context 9 [10] Context 10 [11] Context 11 [12] Context 12 [13] Context 13

Signs and Symptoms of Splenic Infarction

Splenic infarction, a condition where the blood supply to the spleen is compromised, can manifest in various ways depending on its severity. The following are some common signs and symptoms associated with splenic infarction:

• Pain: Pain in the upper left abdomen or left hip area is a frequent symptom, ranging from mild to severe [1].
• Chest pain or fast heartbeat: Some individuals may experience chest pain or a rapid heartbeat due to the body's response to the infarction [1].
• Fever: A fever temperature greater than 38 °C can occur in approximately 36% of cases [10].
• Blood work abnormalities: Elevated white blood cell count (WBC) and lactate dehydrogenase (LDH) levels are common laboratory findings [10].
• Nausea, vomiting, and fatigue: These symptoms can also be present, although they may not always be directly related to the spleen area.
• Referred pain to the left shoulder: Some individuals may experience referred pain in the left shoulder due to the splenic infarction's proximity to the diaphragm [6].
• Abdominal tenderness and guarding: The affected area may become tender and guard-like, indicating inflammation or irritation.

It is essential to note that some cases of splenic infarction can be asymptomatic, especially if the condition is mild. However, if you experience any of these symptoms, it is crucial to seek medical attention promptly.

References:

[1] Context result 1 [6] Context result 6 [10] Context result 10

Splenic infarction can be diagnosed through various diagnostic tests, which are crucial for an accurate diagnosis and treatment plan.

Imaging Tests

• Computed Tomography (CT) Scan: A CT scan with contrast is the preferred diagnostic test for splenic infarction. It can assess the number of infarcts, determine the extent of thrombosis, identify possible sources, and evaluate for complications such as abscesses or hemorrhage [12][13]. A CT scan can also help differentiate between splenic infarction and other conditions that may present with similar symptoms.
• Magnetic Resonance Imaging (MRI): MRI is another imaging modality that can be used to diagnose splenic infarction. However, it is not as commonly used as CT scans in this context [9].
• Ultrasound: Ultrasound can also be used to diagnose splenic infarction, especially in the hyperacute setting. However, its sensitivity and specificity may vary depending on the expertise of the operator and the quality of the equipment [13].

Other Diagnostic Tests

• Blood Tests: Blood tests, including complete blood count (CBC), liver function tests (LFTs), and electrolyte levels, can help identify any underlying conditions that may be contributing to splenic infarction.
• Radioisotope Scans: Radioisotope scans can also be used to diagnose splenic infarction, although they are less commonly used than CT scans or ultrasound [11].

Diagnostic Imaging in the Emergency Department

Imaging is central in diagnosing splenic infarction in the emergency department. The recommended modality for diagnosis in the ED is a CT abdomen with IV contrast, ideally performed during the conventional portal venous phase [12][13]. This can help assess the number of infarcts, determine the extent of thrombosis, identify possible sources, and evaluate for complications such as abscesses or hemorrhage.

In conclusion, splenic infarction can be diagnosed through various diagnostic tests, including imaging tests like CT scans, MRI, and ultrasound. Blood tests and other diagnostic tests may also be used to help identify underlying conditions that may be contributing to the infarction.

Treatment Options for Splenic Infarction

Splenic infarction, also known as splenic ischemia, can be treated with various medications and supportive care to manage symptoms and prevent complications.

• Anticoagulants: These drugs help reduce the formation of clots in the spleen, thus preventing further damage. Studies have shown that anticoagulant therapy is associated with decreased long-term mortality in splenic infarction patients [4].
• Pain management: Hydration and pain relief are essential to manage symptoms such as abdominal pain and discomfort.
• Supportive care: Patients may require hospital admission for supportive treatment, monitoring, and further diagnostic testing. Supportive care includes analgesics, hydration, anti-emetics, and other means of managing symptoms [15].

Medications for Splenic Infarction

The best medicines for splenic infarction include:

• Anticoagulants: These are the primary medications used to treat splenic infarction. They help prevent further clotting in the spleen.
• Pain relievers: Analgesics such as acetaminophen or ibuprofen can be prescribed to manage pain and discomfort.

Important Considerations

It's essential to note that treatment options for splenic infarction vary depending on the underlying causative disease state. If the cause is infection, treatment should target that specific condition [13].

In some cases, surgical intervention such as splenectomy may be necessary if symptoms persist or complications occur.

References:

[4] CC Yen et al., "Anticoagulant Therapy Is Associated With Decreased Long-Term Mortality in Splenic Infarction Patients: A Multicenter Study" (2021)

[15] M Howell IV, "Splenic infarction treatment and management" (no date specified)

Differential Diagnosis of Splenic Infarction

Splenic infarction, a rare phenomenon, requires careful consideration of various differential diagnoses to identify the underlying cause. The following conditions should be considered in the differential diagnosis of splenic infarction:

• Liver laceration: A potential differential diagnosis for splenic injuries, liver laceration can present with similar symptoms and imaging characteristics.
• Retroperitoneal bleeding: This condition can also mimic the presentation of splenic infarction, particularly if there is significant blood loss.
• Diaphragmatic injury: Trauma to the diaphragm can lead to complications that may be mistaken for splenic infarction.
• Pancreas injury: Pancreatitis or pancreatic trauma can present with similar symptoms and imaging findings as splenic infarction.

Other Considerations

In addition to these specific conditions, other factors should also be considered in the differential diagnosis of splenic infarction:

• Splenic lesions: Incidental discoveries at imaging may require further investigation to determine the cause.
• Hypercoagulable states or thromboembolic events: These conditions can increase the risk of splenic infarction.
• Hypersplenism associated infarction: Increased blood flow to the spleen can lead to infarction.

References

• Splenic infarct has a characteristic appearance in the acute phase, but may be mistaken with other mass lesions as they age or develop complications [5].
• The differential diagnosis of splenic injuries includes liver laceration, retroperitoneal bleeding, diaphragmatic injury, and pancreas injury [3].
• Splenic infarction is associated with a broader spectrum of systemic and abdominal disorders than previously reported [14].

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