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FACP. Colegio de médicos de Tarragona Nº 4305520 / fgcapriles@gmail.com

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Tuesday, August 24, 2021

Splenic Infarction

emDocs - August 23, 2021 - By Marshall Howell and Eliot Blum
Reviewed by: Alex Koyfman and Brit Long
Clinical Pearls
  • The classical presentation of splenic infarction is a patient with left-sided abdominal pain, nausea, vomiting, and fever, but actual presentations are often ambiguous and mimic other pathologies.
  • In patients under 40, the most common cause of infarction is a hematologic or hypercoagulable disorder. In those over 40, most infarctions are the result of thromboembolic disease.
  • The gold standard for diagnosis is abdominal CT with contrast. Ultrasound may be useful in the unstable patient to distinguish infarction from splenic rupture or subcapsular hemorrhage.
  • ~38% of splenic infarctions are the first presentation of an underlying disorder. Begin the investigation in the ED with an EKG, blood cultures, and echo (if possible).
  • Stable patients with controlled pain may be admitted or observed with symptomatic care and appropriate consults based upon the most likely etiology. Unstable patients or those with signs of abscess or hemorrhage require admission with surgical and possible IR consultation