Thromboembolic splenic infarction

Abstract

Splenic infarction occurs as a consequence of systemic thromboembolization in association with several cardiovascular disorders. We describe a case of splenic infarction in a patient who had paroxysmal atrial fibrillation after aortic valve replacement. In an autopsy series of 96 consecutive cases of splenic infarction, only 10% had been suspected clinically even though the splenic infarctions had contributed substantially to morbidity and mortality in 44% of the cases. Thromboembolic causes were responsible for the splenic infarcts in 67% of the cases, and concomitant infarcts in other organ systems were found in 62%. Embolization of atheromatous debris from the aorta, thrombotic elements from the left ventricle (in dilated cardiomyopathy and acute myocardial infarction), and vegetations from infected valves are the most common settings in which thromboembolic splenic infarcts are noted. The clinical picture associated with splenic infarction is typically nonspecific; manifestations may include fever, tachycardia, and left-upper-quadrant tenderness. Computed tomographic scanning and, to a lesser degree, ultrasonography are the imaging techniques of choice for diagnosing splenic infarction.