Splenic infarct

Question 1

What is a splenic infarct?

Answer 1

occlusion of the splenic artery or one of its branches causing necrosis

Question 2

Why is infarction not complete in a splenic infarct?

Answer 2

due to the spleen being supplied by the splenic artery and also the short gastric arteries

Question 3

What is the cause of a splenic infarct?

Answer 3

haematological disease and thromboembolism, vasculitis, trauma, collagen tissue diseases or surgery

Question 4

What are the clinical features of a splenic infarct?

Answer 4

left upper quadrant abdominal pain radiation to the left shoulder (Kehrs sign) fever, nausea, vomiting, pleuritic chest pain, asymptomatic, LUQ tenderness

Question 5

What are the differential diagnosis of a splenic infarct?

Answer 5

Peptic ulcer disease, pyelonephritis, left sided basal pneumonia

Question 6

What are the investigations for a splenic infarct?

Answer 6

CT abdominal scan with IV contrast, routine bloods

Question 7

What are the radiographic features of a splenic infarct?

Answer 7

As the IV contrast cannot reach the infarcted area, a segmental wedge of hypoattenuated tissue becomes visible on CT scanning (Fig. 2), the apex of the wedge pointing to the hilum of the spleen from the segmental branching of the splenic artery.

If the splenic artery, rather than one of its segmental branches, is affected then the entire spleen will be hypoattenuated.

Following treatment, most cases are followed up with repeat CT scanning, which will show either full resolution, fibrosis of the original infarct, or liquefaction of the affected region.

Question 8

What is the management for splenic infarct?

Answer 8

analgesia, IV hydration, cause of infarction, splenectomy should be avoided due to overwhelming post splenectomy infection (OPSI) syndrome

Question 9

If someone has there spleen removed what should be done?

Answer 9

low dose antibiotic cover

Question 10

What are the complications of spleen infarct?

Answer 10

splenic abscess, auto splenectomy