The spleen is a large lymphatic organ located on left upper quadrant in abdomen. Its main function is to produce white blood cells, store red blood cells, filter dead red blood cells, and remove bacteria. It is considered to be an important organ of immune system. Splenic infarction occurs if the blood flow to spleen is obstructed either by a blood clot, a plaque, trauma, infection etc. When blood flow is obstructed, spleen does not get enough oxygen. This can cause ischemia and finally death of the splenic tissue or infarction in medical terminology.
Pain and tenderness in upper left flank, chest pain, rapid heart rate, enlarged abdomen, and fever are some of the symptoms of splenic infarction. Treatment for infarction of spleen is medical or surgical removal of spleen. This depends on extent of damage and associated complication if present. For example in case of rupture of spleen, patient may require urgent surgery for removing spleen.
What Causes Splenic Infarction?
Splenic infarction can occur due to many reasons.
- Infarction of spleen can be caused due to decrease or blockage of blood supply to the spleen. When blood flow to spleen is compromised, the spleen remains devoid of oxygen which in turn causes necrosis or death of spleen tissue. Infarction can occur if there is blockage in splenic artery. Blockage can be due to a clot or infection or even a blunt injury to the spleen.
- Certain infections and disorders such as cytomegalovirus infection, malaria, infectious mononeucleosis, or inherited clotting disorders can cause plaque formation in the blood vessel. This plaque can compromise blood flow to spleen leading to ischemia and infarction of the spleen.
- Heart conditions such as heart valve disease, atrial fibrillation, myocardial infarction all can cause blockage in the blood vessel supplying blood to the spleen. This can cause spleen infarction.
- Person suffering from sickle cell anemia has increased risk of developing splenic infarction. Other hemoglobinopathies such as polycythemia vera, idiopathic venous thrombosis all can cause splenic infarction.
- Infarction of spleen can be caused by aortic dissection, torsion of splenic artery or compression of the artery from a tumor all can compromise blood flow to spleen resulting death of spleen tissue.
- Medicines that cause vasoconstriction increase the risk of vasospasm and thrombosis which may ultimately lead to splenic infarction.
Signs And Symptoms Of Splenic Infarction
The symptoms of splenic infarction depend on the underlying cause and extent of damage to the spleen. In mild form of splenic infarction, patient may not experience symptoms. However, when present the signs and symptoms of splenic infarction are as follows:
- Excruciating pain in left upper quadrant of abdomen.
- The area over spleen is tender to touch.
- Left flank pain
- Increased heart rate and palpitation.
- Distension of abdomen
- Disorientation and mental confusion caused due to septic shock in case of complications arising from splenic infarction such as spleen abscess or rupture of spleen.
- Fever and chill
- Nausea and vomiting
Diagnosis And Treatment Of Splenic Infarction
Following steps will help in diagnosis of splenic infarction:
- Medical history.
- Clinical examination of abdomen.
- CT scan of abdomen with intravenous contrast imaging. This is important and gold standard investigation to confirm diagnosis of splenic infarction.
- Sonography of abdomen.
- Complete blood count.
- If needed angiography.
In majority of cases splenic infarction is caused due to a potential serious underlying cause. Hence the aim of the treating physician is to identify the cause and treat the same. This will help in treatment of splenic infarction. Many cases of splenic infarction are mild and often go unnoticed, especially if a small part of spleen is damaged.
Medical therapy of splenic infarction consists of use of pain killers so that patient feel relieved from pain. In case of massive splenic infarct, where the extent of infarction is large or if there is development of complications such as splenic abscess or rupture of spleen, surgery may be necessary. Surgical removal of spleen is kept as a last resort.