THE CLINICAL SPECTRUM OF SPLENIC INFARCTION

Two recent cases of splenic infarction of unusual cause stimulated a r eview of our experience with this condition. We conducted a retrospect ive chart review of selected patients with pathologic diagnosis of spl enic infarction seen at a large metropolitan private teaching hospital during the past 30 years. Variables analyzed included sex, age, etiol ogy of infarction, underlying diseases, diagnostic tests, splenic path ology, and complications. Splenic infarction occurred in 59 patients ( 33 male and 26 female; average age, 55 years; range, 2-87 years). Etio logies included hematologic disorders (n = 35), thromboembolic disorde rs (n = 17), and other diseases (n = 7). Symptoms were present in 69 p er cent of the patients and included abdominal pain, fever and chills, and constitutional symptoms; 18 patients were asymptomatic. Patients with nonmalignant hematologic conditions were often asymptomatic (55%) ; abdominal pain was common in all groups, and fever was especially co mmon in patients with embolic conditions (70%). CT scan was the most f requent radiologic study. Patients with hematologic conditions usually were explored for complications of those conditions (69%), while comp lications of splenic infarction were a frequent indication for operati on in patients with emboli (60%). Overall morbidity was 36 per cent, w ith pulmonary complications most frequent, and mortality was 5 per cen t. We conclude that splenic infarction must be suspected in patients w ith known hematologic or thromboembolic conditions who develop left up per quadrant pain and signs of localized or systemic inflammation. CT scan is currently the preferred diagnostic test, but ultimate diagnosi s depends on pathologic examination of the spleen, Surgical complicati ons of splenic infarction include abscess and rupture.