What is Splenic Infarcts?
The spleen is an organ that helps create blood cells, filters out old blood cells, and helps the immune system fight against certain types of bacteria. A splenic infarction happens when the blood supply to the spleen is blocked, leading to tissue damage and even death (necrosis). This blockage, or occlusion, can result from different causes like blockages in the arteries or veins, usually due to clumps of cells or blood clots, or because of an overload of abnormal cells.
The infarction, or damage, can affect a small area of the spleen or the entire organ, depending on which blood vessel is blocked. Many different conditions can cause a splenic infarction. The impact of the infarction often depends on what caused it in the first place. Symptoms usually include pain on the left side of the abdomen, particularly in people with blood disorders, cancers that spread through the blood, history of blunt abdominal trauma, conditions causing excessive blood clotting, or illnesses that lead to blockages in the blood vessels.
Treatment options for a splenic infarction can vary from supportive care to removing the spleen (splenectomy). Interestingly, doctors sometimes deliberately cause a splenic infarction to treat bleeding from a spleen injury. This is done via splenic embolization, a procedure that blocks the blood supply to the spleen. Splenic embolization is also used to treat severe portal hypertension (high blood pressure in the vein leading to the liver) and to lessen blood loss during spleen removal surgery.
What Causes Splenic Infarcts?
Splenic infarction, or the blockage of blood supply to the spleen, is often caused by blood clots or diseases that affect the blood. For people under 40, the leading cause is usually a blood disease. There are several specific reasons someone might experience a splenic infarction:
* Blood cancers like leukemia or lymphoma or diseases like myelofibrosis
* Conditions that make blood clots more likely (such as sickle cell disease, conditions with decreased proteins that prevent clotting like protein C and S, polycythemia vera which causes too many red blood cells, lupus anticoagulant which increases blood clotting, using estrogen not naturally produced by the body, and other kind of cancers)
* Health issues that might cause blood clots, like irregular heart rhythm, heart infection, a hole in the heart that didn’t close the way it should after birth, or artificial heart valves
* Damage to the abdomen
* Pancreas problems like inflammation or masses that put pressure on the pancreas
Another cause that has been mentioned, though less common, includes autoimmune and collagen vascular diseases, where the body’s immune system attacks itself. Lastly, a condition called “wandering spleen”, where the spleen can move about in the belly, has also been recorded to cause this issue.
Risk Factors and Frequency for Splenic Infarcts
Splenic infarcts, although not a common reason for tummy pain, are becoming more recognizable. This is thought to be due to more frequent use of abdominal imaging, splenic embolization techniques (a procedure to block blood flow to the spleen), and non-surgical treatments for spleen injuries caused by trauma. This condition can affect people of any age. However, those under 40 are more likely to have a related blood disease, while those over 40 are more likely to get a splenic infarct due to blood clot-related diseases.
Signs and Symptoms of Splenic Infarcts
Splenic infarction, which is a rare cause of abdominal pain, is often diagnosed on the basis of other underlying illnesses. One study in 2010 sought to gain a better understanding of splenic infarction. The researchers reviewed the cases of 26 patients admitted to the hospital with a diagnosis of splenic infarction. Here’s what they found:
- The average patient age was 52 years
- 50% of patients reported pain in the left side of their abdomen
- 36% had tenderness in the left side of their abdomen
- 32% had an enlarged spleen
- 31% showed no symptoms or signs in the spleen area
- 36% had a fever higher than 38 °C
- 56% had a white blood cell count greater than 12,000
- 71% had elevated levels of LDH, an enzyme that rises when there is tissue damage
- 32% experienced nausea and/or vomiting
Interesting to note, in 21 of the 26 patients, the diagnosis of a splenic infarct helped to identify a previously unknown underlying illness.
Testing for Splenic Infarcts
If you’re experiencing abdominal pain, it could potentially be due to a rare condition called a splenic infarct, which happens when the spleen doesn’t get enough blood supply. However, abdominal pain can have a multitude of causes, so your doctor will need to check out several possibilities.
Your doctor might run lab tests to determine the most likely source of your pain. The tests could indicate liver problems, pancreas issues, or even a splenic infarct. Tests that show high levels of white blood cells or an enzyme called lactate dehydrogenase (LDH) may suggest a splenic infarct. However, these factors alone aren’t enough for a definitive diagnosis.
To accurately diagnose a splenic infarct, radiographic tests, like an abdominal CT scan with intravenous contrast, are usually needed. This type of scan creates images of the inside of your body that can help your doctor identify this uncommon condition.
During the earliest stages of a splenic infarct, it appears on a CT scan as a wedge-shaped area within the spleen. As the infarction progresses or “matures”, the appearance might change — the affected area could return to normal, liquidize, or become contracted or scarred.
An abdominal ultrasound, another imaging technique, can also detect a splenic infarct. In this case, a hypoechoic or less echo-producing, wedge-shaped region within the spleen suggests an infarct. Over time, this area could look more echo-producing or “hyperechoic” and the outer layer of the spleen might look like it’s shrinking in.
Treatment Options for Splenic Infarcts
The treatment of spleen infarction, which is a condition where blood flow to the spleen is blocked, depends largely on what caused it in the first place. For non-infectious cases, pain relief medications, fluids, anti-nausea drugs, and other supportive treatments may be used. Hospitalization might be necessary for monitoring, additional tests, and to provide the required treatments if it’s still unclear what caused the condition.
If the infarction happened due to something called sickle cell hemoglobinopathies, which are genetic disorders that affect the red blood cells, treatments to correct the levels of oxygen and acidity in the body may be needed. If the infarction was caused by septic emboli (clots formed by bacteria), intravenous antibiotics and further heart examinations may be necessary.
People who have an underlying blood disease or autoimmune disease might need to consult with specialists in hematology (study of blood), oncology (study of cancer), or rheumatology (study of disorders affecting joints and muscles). Generally, abdominal pain from uncomplicated cases of spleen infarction gets better on its own in about one to two weeks.
Cases involving traumatic injury to the spleen, abnormal blood vessels, or unstable blood pressure might require a surgical evaluation. Spleen infarction can also lead to serious complications like forming of a pseudocyst (a false cyst), abscess (collection of pus), bleeding, rupturing of the spleen, and aneurysm (a bulging blood vessel). Complications such as infection in the affected spleen tissue leading to abscess or bleeding transformation may need urgent surgical consultation.
What else can Splenic Infarcts be?
When looking at certain medical conditions, it’s important to also consider, or ‘rule out’, other potential conditions that might be causing the symptoms you’re experiencing. For instance, here are some conditions that might be considered:
- Acute leukemias (a type of blood cancer)
- Cardioembolic origin (a condition where a blood clot forms in the heart and travels to the brain)
- Cytomegalovirus (a common virus that can affect almost any organ system in the body)
- Hemoglobinopathy (a group of disorders affecting red blood cells)
- Infectious mononucleosis (also known as ‘mono’ or the ‘kissing disease’)
- Infective endocarditis (an infection of the inner layer of the heart)
- Myelodysplastic syndromes (a group of disorders caused by poorly formed blood cells)
- Myelofibrosis (a serious bone marrow disorder)
- Wandering spleen (a rare condition where the spleen isn’t in its usual position)
Understanding these possibilities can help medical professionals make the right diagnosis and treatment for patients.
