Editing Splenic infarct


== '''Principles''' ==

* Most infarcts occur for a reason - either embolic or because of a prothrombotic state - and the cause needs to be found
** Older patients - cardioembolic/atherosclerotic
** Younger patients - APS, haematological disorders, infections
* Most patients get anticoagulation
* Intervention is reserved for complications - abscess, haemorrhage

== '''Risk factors''' ==

* 72% had a comorbidity a/w splenic infarction

== '''Aetiology''' ==

=== '''Embolus (62.5% in one case series)''' ===

** Cardiogenic
*** AF
*** AMI
*** Iatrogenic - after a cardiac procedure
*** Infective endocarditis
*** Valvular
**** Mitral valve disease/replacement
**** Aortic valve replacement
** Aortic
** Paradoxical

=== '''Thrombosis''' ===

** Infection-associated - pancreatic abscess, sepsis, malaria
** Autoimmune disease - lupus, APS
** Haematological disease - myeloproliferative disorder, myelodysplastic syndrome, sickle cell disease
*** Most common cause in patients under 40
*** CML especially associated with splenic infarcts
** Cryptogenic - actually unusual
** Splenic vein/PV thrombosis
** Trauma
** Atherosclerosis

== '''Presentation''' ==

* Pain 85%
** LUQ pain 50%
* WCC elevated 30%

== '''Complications''' ==

* Can transform into abscess
* Haemorrhagic necrosis - unlikely
* Persistent pain longer than 2/52 could be an indication for splenectomy

== '''Investigation''' ==

* CT - arterial phase to look for proximal sources of emboli, and perhaps PV phase to assess for local anatomy/complications etc. Remember to look for emboli to other organs, including limbs.
* ECG
* Echo?
* Holter?
* BCs
* Haematology workup: JAK2/APS

== '''Management''' ==

* Anticoagulation if there is a prothrombotic state, cardioembolic source, malignancy, thrombophilia, or a truly cryptogenic infarct
* Anticoagulation not used in sickle cell disease
* If sepsis/fever, treat initially for splenic abscess
* If can't find source, needs thrombophilia panel, echo, Holter, etc

[[Category:Spleen]]