A practical approach to infarction of the spleen as a rare manifestation of multiple common diseases

Figures & data

Table 1. Clinical and laboratory characteristics of subjects at presentation.

Age, median (range)	70 (25–92)
Females, n (%)	59 (65.6)
Signs and symptoms, n (%)
Abdominal pain	74 (82.2)
Fever	34 (34.8)
Vomiting	19 (21.1)
Flank pain	17 (18.9)
Chest pain	7 (7.8)
Dyspnea	5 (5.6)
Problem list, n (%)
Hypertension	57 (63.3)
Dyslipidemia	42 (46.7)
Atrial fibrillation	34 (37.8)
Diabetes mellitus	31 (34.4)
Ischemic heart disease	30 (33.3)
Heart failure	23 (25.6)
Stroke	19 (21.1)
Chronic kidney disease	15 (16.7)
Valvular heart disease	8 (8.9)
Peripheral vascular disease	5 (5.6)
Myeloproliferative neoplam	5 (5.6)
Previous venous thrombotic events	4 (4.4)
Lymphoproliferative neoplasm	3 (3.3)
Antiphospholipid syndrome	2 (2.2)
Solid malignancy	2 (2.2)
Acute leukemia	1 (1.1)
Antithrombotic therapy, n (%)
Antiplatelet drugs	27 (30)
Anticoagulants	12 (13.3)
Antiplatelets + anticoagulant	7 (7.8)
Total	46 (51.1)
Laboratory tests
Mean ± SD (normal range)
WBC ×10^3 µL^a	14.3 ± 10.8 (4.8–10.8)
Hb, g dL^−1^b	12.8 ± 2.1 (13.5–17.5)
Plt, ×10^3/μL^a	276 ± 156 (150–400)
D-Dimer, ng mL^−1^b; n = 14	2815 ± 1484 (0–500)
LDH, U L^−1; n = 87^b	797 ± 804 (230–460)
Albumin, g dL^−1; n = 88^a	3.4 ± 0.6 (3.5–5.5)
CRP, mg dL^−1; n = 40^b	13.1 ± 10.1 (0–0.5)

^a % subjects with increased values: WBC, 67%; Plt, 7.8%; D-dimer, 100%; LDH, 72%; CRP, 97.5%.

^b % subjects with decreased values: Hb, 38%; albumin, 47%.

Table 2. Newly diagnosed diseases and related findings in patients admitted with SI.

Diagnosis	N (%)
Infectious disease^a	11 (12.2)
Vascular disease	10 (11.1)
Cardiac disease	7 (7.8)
AF	5 (5.6)
JAK2 MPN	5 (5.6)
Solid tumor	3 (3.3)
APLS	3 (3.3)
AF + cardiac disease	1 (1.1)
Total	34 (37.8)

^a Including endocarditis and nonendocarditis infectious diseases.

AF: atrial fibrillation; MPN: myeloproliferative neoplasm; APLS: antiphospholipid syndrome.

Table 3. Findings on abdominal CT in addition to splenic infarcts.

CT findings	N (%)
Renal infarcts	20 (22)
Intestinal ischemia	6 (7)
Atherosclerosis	4 (4)
Aortic mural thrombi	4 (4)
Malignant tumor	3 (3)
Emphysematous pyelonephritis	2 (2)
Left atrial thrombus	2 (2)
Pulmonary emboli	1 (1)
Obstructive uropathy	1 (1)
Celiac artery dissection	1 (1)
Benign liver tumor	1 (1)
Total	45 (50)

Table 4. Causes and etiologic factors of splenic infarction.

Aetiology	N (%)
Cardioembolic
AF	28 (31.1)
AF + Cardiac abnormality	12 (13.3)
Infectious endocarditis	2 (2.2)
Other	7 (7.8)
Total	49 (54.4)
Vascular
Atherosclerosis	13 (14.4)
Other	5 (5.6)
Total	18 (20)
Haematologic disease
MPN total	10 (11.1)
Mutated JAK2 MPN	7 (7.8)
Haematological malignancy	4 (4.4)
Total	14 (15.6)
Infectious (nonendocarditis)	9 (10)
Solid tumor	5 (5.6)
APLS	5 (5.6)
Cryptogenic	5 (5.6)
Miscellaneous	3 (3.3)
Iatrogenic	1 (1.1)
Multiple causes	19 (21.1)

AF: atrial fibrillation; MPN: myeloproliferative neoplasm; APLS: antiphospholipid syndrome.

Figure 1. Distribution of SI etiologies with patient age. AF, atrial fibrillation; athero, atherosclerosis; APLS, anti phospholipid syndrome; JAK2, MPN with JAK2. V617F mutation; infect, infections other than endocarditis; cancer, solid malignancies; vasc, vascular diseases other than atherosclerosis; cardiac, cardiac diseases without AF. *, p < .05.

Table 5. Yield of diagnostic tests for newly diagnosed etiologies.

Test	Yield (% of 90 cases)
Abdominal CT	9/90 (10)
ECG	6/90 (7)
TTE	9/63 (10)
Blood cultures	8/52 (9)
APLS	3/33 (3)
Congenital thrombophilia testing	0/24 (0)
TEE	6/14 (7)
JAK2 mutation V617F	5/13 (6)
Collagen diseases testing	0/12 (0)

TTE: trans-thoracic echocardiography; APLS: antiphospholipid syndrome; TEE: trans-esophageal echocardiography.