splenic infarct Flashcards
what is a splenic infarct?
infarction caused by occlusion of the splenic artery or one of its branches, resulting in tissue necrosis
rare events
why is a splenic infarct usually not complete?
spleen is supplied by the splenic artery (from the coeliac axis) and the short gastric arteries (from the left gastroepiploic artery) infarction is often not complete due to collateral circulation
what are the most common causes of a splenic infarct?
- haematological disease, through congestion of splenic circulation by abnormal cells , made worse in conditions by anaemia and splenomegaly. Such disease includes lymphoma, polycythaemia rubra vera, hyper coagulable states.
- embolic disorders e.g endocarditis, AF, fibrillation, infected aneurysm grafts, or post MI mural thrombus
- thromboembolism
- vasculitis
- trauma e.g blunt or torsion
- collagen tissue disease
- surgery e.g pancreatectomy or liver transplant
what are the clinical features of a splenic infarct?
- LUQ abdo pain that may radiate to left shoulder
- fever
- nausea and vomiting
- pleurites chest pain
can be asymptomatic and diagnosed purely by imaging or explorative surgery
on examination
- LUQ tenderness
what are the differentials for LUQ pain?
- peptic ulcer disease
- pyelonephritis
- ureteric colic
- left sided basal pneumonia
what investigations are done into splenic infarcts?
- CT abdo scan with IV contrast. Necrotic area won’t be visible on CT scan
- routine bloods including FBC, U&E, LFTs and coagulation screen
- high WCC usually seen and raised d dimer levels may help diagnosis
what is the long term management for a splenic infarct?
may need IV hydration and analgesia on presentation if acute
identify underlying cause and manage
avoid splenectomy to avoid risk of overwhelming post splenectomy infection (OPSI)
if symptoms persist may be unavoidable
due to spleens role in protection against encapsulated bacteria, vaccinate against s pneumoniae, N mengitidis, H influenza in extensive splenic infarcts.
also give low dose antibiotic cover, ideally penicillin V due to inability to clear encapsulated bacteria without spleen
how can the cause of an infarction be identified?
investigations
haematologist help and an ECHO
consider long term anticoagulation
what is a splenic abscess?
a complication of splenic infarction when underlying cause was a non sterile embolus e.g infective endocarditis
embolus seeds infection into necrotic splenic tissue. Can be hard to differentiate from a uncomplicated infarction. Can base diagnosis on ct scan viewed by experienced radiologist, especially when combined with raised inflammatory markers
most cases only confirmed with explorative surgery
what is an auto splenectomy?
a rare condition that results in asplenism
repeated splenic infarctions results in progressive fibrosis and atrophy of spleen
this can lead to complete atrophy of the spleen, called autosplenectomy
most common cause is sickle cell anaemia, with recurrent sickle cell crisis leading to recurrent occlusion of the splenic atrophy. if this keeps happening through childhood, can get asplenism but adulthood