Splenic Infarct Clinical Presentation

Updated: Nov 28, 2018
  • Author: Manish Parikh, MD; Chief Editor: John Geibel, MD, DSc, MSc, AGAF  more...
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Presentation

History and Physical Examination

The clinical spectrum ranges from asymptomatic infarction (discovered incidentally on radiologic or postmortem studies or at laparoscopy or laparotomy for another indication) to hemorrhagic shock (secondary to massive subcapsular hemorrhage with free rupture into the peritoneal cavity). Approximately one third of splenic infarcts are clinically occult.

The most common presenting symptom is left-upper-quadrant abdominal pain (up to 70%). Additional symptoms include fever and chills, nausea and vomiting, pleuritic chest pain, and left shoulder pain (Kehr sign).

Septic thromboemboli may result in splenic abscesses, which present with sepsis and left upper abdominal pain.

In the series of Nores et al, most of the patients with thromboembolic infarction were symptomatic; 70% of patients with emboli were febrile, and 86% of individuals with thrombosis had abdominal pain. [11]

In a 10-year retrospective study, Antopolsky et al examined clinical presentations in 49 episodes of acute splenic infarction. The most common symptom was either abdominal or left flank pain (80% of episodes), while the most common sign was left-upper-quadrant tenderness (35% of episodes). In 16.6% of patients, splenic infarction was the presenting symptom of an underlying disease. No in-hospital mortality or serious complications occurred in the cohort. [17]