Splenic infarction
Encyclopedia
In medicine
, splenic infarction is a condition in which oxygen supply to the spleen
is interrupted, leading to partial or complete infarction
(tissue death due to oxygen shortage) in the organ.
Splenic infarction occurs when the splenic artery
or one of its branches are occluded, for example by a blood clot. Although it can occur asymptomatic
ally, the typical symptom is severe pain
in the left upper quadrant of the abdomen
, sometimes radiating to the left shoulder. Fever and chills develop in some cases. It has to be differentiated from other causes of acute abdomen
.
An abdominal CT scan is the most commonly used modality to confirm the diagnosis, although abdominal ultrasound can also contribute.
There is no specific treatment, except treating the underlying disorder and providing adequate pain relief. Splenectomy is only required if complications ensue; surgical removal predisposes to overwhelming post-splenectomy infection
s.
In one series of 59 patients, mortality amounted to 5%. Complications include a ruptured spleen
, hemorrhage, splenic abscess (for example, if the underlying cause is endocarditis
) or pseudocyst
formation. Splenectomy may be warranted for persistent pseudocysts due to the high risk of subsequent rupture.
s (such as infectious mononucleosis
, cytomegalovirus infection, malaria
or babesiosis
), inherited clotting disorders (thrombophilia
, such as Factor V Leiden
, antiphospholipid syndrome
), malignancy (such as pancreatic cancer
) or metastasis
, or a combination of these factors.
In some conditions, blood clots form in one part of the circulatory system and then dislodge and travel to another part of the body, which could include the spleen. These emboligenic
disorders include atrial fibrillation
, patent foramen ovale, endocarditis
or cholesterol embolism
.
Splenic infarction is also more common in hematological disorders with associated splenomegaly
, such as the myeloproliferative disorders. Other causes of splenomegaly
(for example, Gaucher disease or hemoglobinopathies
) can also predispose to infarction. Splenic infarction can also result from a sickle cell crisis in patients with sickle cell anemia. Both splenomegaly and a tendency towards clot formation feature in this condition. In sickle cell disease, repeated splenic infarctions lead to a non-function spleen (autosplenectomy
).
Any factor that directly compromises the splenic artery can cause infarction. Examples include abdominal traumas, aortic dissection
, torsion of the splenic artery (for example, in wandering spleen
) or external compression on the artery by a tumor
. It can also be a complication of vascular procedures.
Splenic infarction can be due to vasculitis
or diffuse intravascular coagulation. Various other conditions have been associated with splenic infarction in case reporters, for example Wegener's granulomatosis
or treatment with drugs that predispose to vasospasm
or thrombosis
, like vasoconstrictors used to treat esophageal varices
, sumatriptan
or bevacizumab
.
or splenic injury
. It can also be used prior to splenectomy
for the prevention of blood loss.
Medicine
Medicine is the science and art of healing. It encompasses a variety of health care practices evolved to maintain and restore health by the prevention and treatment of illness....
, splenic infarction is a condition in which oxygen supply to the spleen
Spleen
The spleen is an organ found in virtually all vertebrate animals with important roles in regard to red blood cells and the immune system. In humans, it is located in the left upper quadrant of the abdomen. It removes old red blood cells and holds a reserve of blood in case of hemorrhagic shock...
is interrupted, leading to partial or complete infarction
Infarction
In medicine, infarction refers to tissue death that is caused by a local lack of oxygen due to obstruction of the tissue's blood supply. The resulting lesion is referred to as an infarct.-Causes:...
(tissue death due to oxygen shortage) in the organ.
Splenic infarction occurs when the splenic artery
Splenic artery
In anatomy, the splenic artery is the blood vessel that supplies oxygenated blood to the spleen. It branches from the celiac artery, and follows a course superior to the pancreas.-Branches:...
or one of its branches are occluded, for example by a blood clot. Although it can occur asymptomatic
Asymptomatic
In medicine, a disease is considered asymptomatic if a patient is a carrier for a disease or infection but experiences no symptoms. A condition might be asymptomatic if it fails to show the noticeable symptoms with which it is usually associated. Asymptomatic infections are also called subclinical...
ally, the typical symptom is severe pain
Abdominal pain
Abdominal pain can be one of the symptoms associated with transient disorders or serious disease. Making a definitive diagnosis of the cause of abdominal pain can be difficult, because many diseases can result in this symptom. Abdominal pain is a common problem...
in the left upper quadrant of the abdomen
Left upper quadrant (abdomen)
thumb|right|A Graphic showing Contents of Left upper quadrantThe Left upper quadrant of the human abdomen, often abbreviated as LUQ, is used to refer to a portion of the abdomen that allows doctors to localise pain and tenderness, scars, lumps and other items of interest...
, sometimes radiating to the left shoulder. Fever and chills develop in some cases. It has to be differentiated from other causes of acute abdomen
Acute abdomen
The term acute abdomen refers to a sudden, severe abdominal pain of unclear etiology that is less than 24 hours in duration. It is in many cases a medical emergency, requiring urgent and specific diagnosis...
.
An abdominal CT scan is the most commonly used modality to confirm the diagnosis, although abdominal ultrasound can also contribute.
There is no specific treatment, except treating the underlying disorder and providing adequate pain relief. Splenectomy is only required if complications ensue; surgical removal predisposes to overwhelming post-splenectomy infection
Overwhelming post-splenectomy infection
An overwhelming post-splenectomy infection is a rare but rapidly fatal infection occurring in individuals following removal of the spleen...
s.
In one series of 59 patients, mortality amounted to 5%. Complications include a ruptured spleen
Ruptured spleen
Rupture of the capsule of the spleen, an organ in the upper left part of the abdomen, is a situation that requires immediate medical attention. The rupture of a normal spleen can be caused by trauma, such as a car accident.-Function In the Body:...
, hemorrhage, splenic abscess (for example, if the underlying cause is endocarditis
Endocarditis
Endocarditis is an inflammation of the inner layer of the heart, the endocardium. It usually involves the heart valves . Other structures that may be involved include the interventricular septum, the chordae tendineae, the mural endocardium, or even on intracardiac devices...
) or pseudocyst
Pseudocyst
Pseudocysts are like cysts, but lack epithelial or endothelial cells. Initial management consists of general supportive care. Symptoms and complications caused by pseudocysts require surgery. CT scans are used for initial imaging of cysts, and endoscopic ultrasounds are used in differentiating...
formation. Splenectomy may be warranted for persistent pseudocysts due to the high risk of subsequent rupture.
Causes
Several factors may increase the tendency for clot formation, such as specific infectionInfection
An infection is the colonization of a host organism by parasite species. Infecting parasites seek to use the host's resources to reproduce, often resulting in disease...
s (such as infectious mononucleosis
Infectious mononucleosis
Infectious mononucleosis is an infectious, widespread viral...
, cytomegalovirus infection, malaria
Malaria
Malaria is a mosquito-borne infectious disease of humans and other animals caused by eukaryotic protists of the genus Plasmodium. The disease results from the multiplication of Plasmodium parasites within red blood cells, causing symptoms that typically include fever and headache, in severe cases...
or babesiosis
Babesiosis
Babesiosis is a malaria-like parasitic disease caused by infection with Babesia, a genus of protozoal piroplasms. After trypanosomes, Babesia are thought to be the second most common blood parasites of mammals and they can have a major impact on health of domestic animals in areas without severe...
), inherited clotting disorders (thrombophilia
Thrombophilia
Thrombophilia is an abnormality of blood coagulation that increases the risk of thrombosis . Such abnormalities can be identified in 50% of people who have an episode of thrombosis that was not provoked by other causes...
, such as Factor V Leiden
Factor V Leiden
Factor V Leiden is the name given to a variant of human factor V that causes a hypercoagulability disorder. In this disorder the Leiden variant of factor V cannot be inactivated by activated protein C. Factor V Leiden is the most common hereditary hypercoagulability disorder amongst Eurasians...
, antiphospholipid syndrome
Antiphospholipid syndrome
Antiphospholipid syndrome or antiphospholipid antibody syndrome , often also Hughes syndrome, is an autoimmune, hypercoagulable state caused by antibodies against cell-membrane phospholipids that provokes blood clots in both arteries and veins as well as pregnancy-related complications such as...
), malignancy (such as pancreatic cancer
Pancreatic cancer
Pancreatic cancer refers to a malignant neoplasm of the pancreas. The most common type of pancreatic cancer, accounting for 95% of these tumors is adenocarcinoma, which arises within the exocrine component of the pancreas. A minority arises from the islet cells and is classified as a...
) or metastasis
Metastasis
Metastasis, or metastatic disease , is the spread of a disease from one organ or part to another non-adjacent organ or part. It was previously thought that only malignant tumor cells and infections have the capacity to metastasize; however, this is being reconsidered due to new research...
, or a combination of these factors.
In some conditions, blood clots form in one part of the circulatory system and then dislodge and travel to another part of the body, which could include the spleen. These emboligenic
Embolism
In medicine, an embolism is the event of lodging of an embolus into a narrow capillary vessel of an arterial bed which causes a blockage in a distant part of the body.Embolization is...
disorders include atrial fibrillation
Atrial fibrillation
Atrial fibrillation is the most common cardiac arrhythmia . It is a common cause of irregular heart beat, identified clinically by taking a pulse. Chaotic electrical activity in the two upper chambers of the heart result in the muscle fibrillating , instead of achieving coordinated contraction...
, patent foramen ovale, endocarditis
Endocarditis
Endocarditis is an inflammation of the inner layer of the heart, the endocardium. It usually involves the heart valves . Other structures that may be involved include the interventricular septum, the chordae tendineae, the mural endocardium, or even on intracardiac devices...
or cholesterol embolism
Cholesterol embolism
Cholesterol embolism occurs when cholesterol is released, usually from an atherosclerotic plaque, and travels along with the bloodsteam to other places in the body, where it obstructs blood vessels...
.
Splenic infarction is also more common in hematological disorders with associated splenomegaly
Splenomegaly
Splenomegaly is an enlargement of the spleen. The spleen usually lies in the left upper quadrant of the human abdomen. It is one of the four cardinal signs of hypersplenism, some reduction in the number of circulating blood cells affecting granulocytes, erythrocytes or platelets in any...
, such as the myeloproliferative disorders. Other causes of splenomegaly
Splenomegaly
Splenomegaly is an enlargement of the spleen. The spleen usually lies in the left upper quadrant of the human abdomen. It is one of the four cardinal signs of hypersplenism, some reduction in the number of circulating blood cells affecting granulocytes, erythrocytes or platelets in any...
(for example, Gaucher disease or hemoglobinopathies
Hemoglobinopathy
Hemoglobinopathy is a kind of genetic defect that results in abnormal structure of one of the globin chains of the hemoglobin molecule. Hemoglobinopathies are inherited single-gene disorders; in most cases, they are inherited as autosomal co-dominant traits. Common hemoglobinopathies include...
) can also predispose to infarction. Splenic infarction can also result from a sickle cell crisis in patients with sickle cell anemia. Both splenomegaly and a tendency towards clot formation feature in this condition. In sickle cell disease, repeated splenic infarctions lead to a non-function spleen (autosplenectomy
Autosplenectomy
An autosplenectomy occurs when a disease damages the spleen to such an extent that it ends up shrunk.-Consequences:...
).
Any factor that directly compromises the splenic artery can cause infarction. Examples include abdominal traumas, aortic dissection
Aortic dissection
Aortic dissection occurs when a tear in the inner wall of the aorta causes blood to flow between the layers of the wall of the aorta and force the layers apart. The dissection typically extends anterograde, but can extend retrograde from the site of the intimal tear. Aortic dissection is a medical...
, torsion of the splenic artery (for example, in wandering spleen
Wandering spleen
Wandering spleen is a rare medical disease caused by the loss or weakening of the ligaments that help to hold the spleen.-Background:...
) or external compression on the artery by a tumor
Tumor
A tumor or tumour is commonly used as a synonym for a neoplasm that appears enlarged in size. Tumor is not synonymous with cancer...
. It can also be a complication of vascular procedures.
Splenic infarction can be due to vasculitis
Vasculitis
Vasculitis refers to a heterogeneous group of disorders that are characterized by inflammatory destruction of blood vessels. Both arteries and veins are affected. Lymphangitis is sometimes considered a type of vasculitis...
or diffuse intravascular coagulation. Various other conditions have been associated with splenic infarction in case reporters, for example Wegener's granulomatosis
Wegener's granulomatosis
Wegener's granulomatosis , more recently granulomatosis with polyangiitis , is an incurable form of vasculitis that affects the nose, lungs, kidneys and other organs. Due to its end-organ damage, it is life-threatening and requires long-term immunosuppression...
or treatment with drugs that predispose to vasospasm
Vasospasm
Vasospasm refers to a condition in which blood vessels spasm, leading to vasoconstriction. This can lead to tissue ischemia and death . Cerebral vasospasm may arise in the context of subarachnoid hemorrhage. Symptomatic vasospasm or delayed cerebral ischemia is a major contributor to...
or thrombosis
Thrombosis
Thrombosis is the formation of a blood clot inside a blood vessel, obstructing the flow of blood through the circulatory system. When a blood vessel is injured, the body uses platelets and fibrin to form a blood clot to prevent blood loss...
, like vasoconstrictors used to treat esophageal varices
Esophageal varices
In medicine , esophageal varices are extremely dilated sub-mucosal veins in the lower esophagus...
, sumatriptan
Sumatriptan
Sumatriptan is a triptan sulfa drug containing a sulfonamide group. It is used for the treatment of migraine headaches. Sumatriptan is produced and marketed by various drug manufacturers with many different trade names such as Sumatriptan, Imitrex, Imigran, Imigran recovery.-Approval and...
or bevacizumab
Bevacizumab
Bevacizumab is a drug that blocks angiogenesis, the growth of new blood vessels. It is commonly used to treat various cancers, including colorectal, lung, breast, kidney, and glioblastomas....
.
Therapeutic splenic infarction
Splenic infarction can be induced for the treatment of such conditions as portal hypertensionPortal hypertension
In medicine, portal hypertension is hypertension in the portal vein and its tributaries.It is often defined as a portal pressure gradient of 10 mmHg or greater.-Causes:Causes can be divided into prehepatic, intrahepatic, and posthepatic...
or splenic injury
Ruptured spleen
Rupture of the capsule of the spleen, an organ in the upper left part of the abdomen, is a situation that requires immediate medical attention. The rupture of a normal spleen can be caused by trauma, such as a car accident.-Function In the Body:...
. It can also be used prior to splenectomy
Splenectomy
A splenectomy is a surgical procedure that partially or completely removes the spleen.-Indications:The spleen, similar in structure to a large lymph node, acts as a blood filter. Current knowledge of its purpose includes the removal of old red blood cells and platelets, and the detection and fight...
for the prevention of blood loss.