Splenic involvement in endocarditis.

Introduction. - Splenic involvement in the course of endocarditis consists in either splenic infarct or abscess. Pathophysiological examinations sugge st the existence of a continuum between the two types of lesion. Signs and symptoms are usually poor or aspecific. Current incidence and diagnostic me thods are rarely reported in recent medical literature. Exegesis. - We report a retrospective study conducted from a questionnaire that was circulated to nine French medical units. Two hundred and twenty fi ve patients with infectious endocarditis according to Duke university crite ria were included in the study. The existence of splenic lesions was invest igated in 153 patients (68%). Splenic involvement was documented in 35 pati ents. Diagnostic methods were: abdominal echography. (n = 77), abdominal CT scan (n = 40), and both techniques (n = 36). The incidence of splenic lesi ons was 9%, 35% and 36%, respectively. Among patients investigated using bo th diagnostic techniques, splenic abnormalities were detected by CT scan in 13 cases and by echography in six cases. Splenic abscess was suspected in nine patients by combining suggestive clinical course and radiological abno rmalities, but was definitively evidenced in only four patients (surgery, n = 2, post-mortem examination, n = 2) presenting with large lesions (greate r than or equal to 8 cm) associated with aortic endocarditis. All other 26 cases were categorized as splenic infarcts; however, diagnosis was confirme d in only two cases (surgery n = 1, autopsy n = 1). Conclusion. - These data suggest that: 1) the incidence of splenic involvem ent during endocarditis is approximately 35%, 2) CT scan is probably superi or to echography for spleen screening, and 3) incidence of abscess requirin g specific surgery is very few, inferior to 2%. (C) 1999 Elsevier, Paris.