Diverse Clinical Conditions Associated With Splenic Infarction

By Will Boggs MD

July 23, 2020

NEW YORK (Reuters Health) - Splenic infarction in adults can be associated with a wide array of clinical conditions, according to a new study.

Classically, splenic infarction presents with acute pain and tenderness in the left upper quadrant or flank area. Today it is being identified in patients with less specific clinical presentations and sometimes as an incidental finding on abdominal CT.

In a report in JAMA Internal Medicine, Dr. Allan S. Brett and colleagues at the University of South Carolina School of Medicine, in Columbia, describe clinical conditions associated with splenic infarction in 163 adult patients (mean age, 57 years).

Only 20% of patients presented with left upper abdominal pain; 47% presented with other areas of abdominal pain and 33% did not have abdominal pain.

Less than a third of patients overall had conditions traditionally associated with splenic infarction: 16% had atrial fibrillation, 9% had cardioembolic conditions other than atrial fibrillation and 6% had hematologic malignancies.

There was a high prevalence of inflammatory or infectious abdominal conditions (16%), sepsis (17%), malignant tumor (20%), and atherosclerosis involving celiac or splenic arteries (21%).

One in five of these patients died during their hospitalization.

"Our study found that splenic infarction is associated with a broader spectrum of systemic and abdominal disorders than previously reported," the authors conclude.

Dr. Ami Schattner of Hebrew University Hadassah, in Jerusalem, who earlier reported an extensive list of conditions underlying splenic infarction in 32 patients admitted over a 10-year period but was not involved in the new study, told Reuters Health by email, "A cause and often more than 1 etiology can be discovered in the vast majority of cases and should be sought if not evident."

Dr. Mougnyan Cox of the University of Pennsylvania Health System, in Philadelphia, previously described causes and predisposing factors in 123 patients presenting with acute nontraumatic splenic infarctions. He told Reuters Health by email, "One of the important take-home points from (the new report) is that acute splenic infarction can be viewed as a marker for more ominous pathology, including cardioembolism, malignancy, and infection, and recognizing this finding on CT may be the index event in a patient at high risk for future cardioembolic events."

"In other words, an incidental discovery of acute splenic infarction could ultimately be lifesaving, as timely initiation of anticoagulation for some of these cardiac conditions may decrease the risk of future stroke or other end-organ ischemia," he said.

"While patients have died as a direct result of acute splenic infarction, this is an uncommon event typically associated with infarction of the entire spleen," said Dr. Cox, who was not part of the new study. "Investigative and therapeutic efforts should be directed at discovering the underlying cause of acute splenic infarction that may place the patient at risk for future harm."

Dr. Brett was unable to provide comments by press time.

SOURCE: https://bit.ly/3j5kDIL JAMA Internal Medicine, online July 13, 2020.