A splenic infarct occurs when the blood supply to the spleen is cut off, causing a portion of the organ’s tissue to die. The spleen, an organ located in the upper left abdomen, acts as a filter for blood, removes old red blood cells, and stores blood and iron. It also plays a part in the body’s immune system by helping to fight off infections. When blood flow through the splenic artery or its branches gets blocked, the tissue is deprived of oxygen and nutrients, leading to damage.
Causes and Risk Factors
One major category of causes involves thromboembolic events, where a blood clot forms elsewhere in the body, breaks free, and travels through the bloodstream to lodge in the splenic artery. Conditions like atrial fibrillation, a type of irregular heartbeat, can cause clots to form in the heart, which may then embolize to the spleen. Similarly, infective endocarditis, an infection of the heart valves, can release clumps of bacteria and cells that block splenic vessels.
Hematologic disorders, or diseases of the blood, are another group of risk factors. Conditions such as sickle cell disease can cause red blood cells to become misshapen, leading to blockages in the small blood vessels of the spleen. Repeated splenic infarcts in individuals with sickle cell disease can eventually lead to a non-functional spleen. Cancers of the blood and bone marrow, like leukemia and lymphoma, can also cause the spleen to become enlarged and congested with abnormal cells, predisposing it to infarction.
Other conditions can also compromise blood flow to the spleen. Autoimmune diseases and certain infections, including mononucleosis and malaria, can trigger inflammation and changes in blood consistency that increase risk. Direct physical trauma to the abdomen from an accident or fall can injure the splenic artery. In rare cases, the spleen may be anatomically unusual, such as a “wandering spleen,” where its supporting ligaments are too loose, allowing the organ to twist on its blood supply.
Signs and Symptoms
The most characteristic sign of a splenic infarct is the sudden onset of intense, sharp pain in the upper left quadrant of the abdomen. This pain frequently radiates towards the left shoulder, a phenomenon known as Kehr’s sign. The discomfort occurs because the nerve that serves the spleen also has connections to the shoulder area, and the brain interprets the pain signals as coming from that region.
Alongside abdominal pain, individuals may experience other systemic symptoms. A low-grade fever and chills can develop as the body’s inflammatory response is activated by the tissue damage in the spleen. Nausea and vomiting are also commonly reported. In some instances, the pain might feel worse with deep breathing, described as pleuritic chest pain.
It is important to recognize that not every splenic infarct produces noticeable symptoms. A significant portion of cases are discovered incidentally during medical imaging performed for unrelated reasons. These asymptomatic infarcts are often smaller and may not involve a large enough area of the spleen to cause significant pain or a systemic reaction. The presence and severity of symptoms often depend on the size of the infarct and the underlying cause.
Diagnosis Process
Confirming a suspected splenic infarct relies heavily on medical imaging that can visualize the organ and its blood supply. The primary diagnostic tool is a contrast-enhanced computed tomography (CT) scan of the abdomen. During this procedure, a special dye is injected into the bloodstream, which highlights blood vessels and organs on the CT images. In a healthy spleen, the tissue will uniformly light up with the contrast dye.
When an infarct is present, the area of dead tissue does not have blood flow, so it does not absorb the dye and appears as a distinct, often wedge-shaped, dark patch on the scan. This classic appearance allows radiologists to confirm the diagnosis with a high degree of certainty. While other imaging techniques like ultrasound or magnetic resonance imaging (MRI) can also detect abnormalities in the spleen, they are less specific for identifying an infarct compared to a contrast-enhanced CT.
Blood tests are also a standard part of the diagnostic workup, but their purpose is not to diagnose the infarct itself. Instead, they are used to investigate the potential underlying cause. For example, blood tests can reveal the presence of abnormal blood cells indicative of a hematologic disorder, signs of infection, or markers that suggest a tendency for blood clot formation. This information helps guide the subsequent treatment plan.
Treatment and Management
The focus of treating a splenic infarct is twofold: managing the immediate symptoms and addressing the underlying condition that caused the blockage. For the infarct itself, treatment is supportive. This involves providing adequate pain relief with analgesic medications to control the abdominal discomfort. Patients may also receive intravenous (IV) fluids to ensure they remain hydrated, especially if they are experiencing nausea or vomiting.
In many cases where the infarct is caused by a thromboembolic event, such as a clot from atrial fibrillation, anticoagulants are a central part of the treatment plan. These medications, often called blood thinners, work to prevent the existing clot from getting larger and reduce the risk of new clots forming. If an infection like endocarditis is the root cause, antibiotics are administered to clear the infection.
Surgical intervention is not usually necessary for the infarct itself. The body will often heal on its own, with the damaged tissue eventually turning into a scar. However, surgery to remove the spleen, known as a splenectomy, may be required if serious complications develop. Most patients can be managed medically without the need for an operation.
Potential Complications and Outlook
While most splenic infarcts resolve without major issues, there are potential complications, though they are not common. One possibility is the formation of a splenic abscess, where the dead tissue becomes infected and fills with pus. Another serious, but rare, complication is splenic rupture, where the weakened organ tears, leading to internal bleeding that can be life-threatening. A splenic pseudocyst, a collection of fluid, can also form in the area of the infarct.
These complications often require more aggressive intervention, such as drainage of an abscess or emergency surgery to remove the spleen if it ruptures. The development of such issues can significantly alter the course of recovery. It is important to seek immediate medical attention for worsening abdominal pain, dizziness, or lightheadedness, as these could be signs of a bleed.
The long-term outlook for a person who has had a splenic infarct is almost entirely dependent on the underlying cause. If the condition that led to the infarct, such as an infection or a one-time blood clot, can be successfully treated and resolved, the prognosis is very good. If the cause is a chronic condition like a blood cancer or sickle cell disease, the focus remains on managing that primary disease to prevent future events.