Splenic infarction: Causes, complications, symptoms, prognosis, and treatment

In order to completely understand what a spleen infarction is, it’s important to learn about the role that the spleen plays in the body. The spleen is a lymphatic organ that’s located in the upper-left abdominal quadrant and its main function is to filter out and store the red blood cells as well as produce white blood cells so that the immune system can function normally.

It’s also responsible for eliminating micro-organisms like bacteria that could cause infections throughout the body and put your health at risk.

Spleen infarction occurs as a result of blockage or lack of proper blood circulation in the spleen. Tissues in the spleen die off due to insufficient oxygen supply, which is typically provided through the bloodstream. This can negatively impact either certain parts of the spleen or the entire organ depending on the exact location and extent of the blockage.

The parts of the spleen that are affected the most by blockage and insufficient or lack of blood supply are known as spleen infarcts. Blockage is usually caused by plaque buildup or blood clotting and these are indicators of certain diseases, infections throughout the body, or the spleen being subjected to blunt trauma.

Eventually, the parts of the spleen that are affected by this blood and oxygen deprivation begin to die off and the spleen ceases to perform its duties, becoming inactive.

What are the causes of spleen infarction?

The etiology or causes of splenic infarction include the following:

• Decreased or complete lack of blood circulation to the spleen or parts of the spleen caused by an extreme blockage in the splenic artery or its surroundings. This can be the result of a blood clot, serious and spreading infection, or the spleen suffering direct blunt force trauma.
• Cytomegalovirus infection, mononucleosis, malaria, babesiosis, and inherited blood clotting disorders can all contribute to plaque buildup in the system that prevents the spleen from receiving sufficient blood and oxygen supply to sustain and keep it healthy
• Conditions like atrial fibrillation, artificial heart valves, endocarditis, patent foramen ovale, ventricular mural thrombus, and myocardial infarct infections that are related to the HIV virus can cause an existing blood clot that formed in one part of the body to spread to other organs, including the spleen. This will result in splenic infarction.
• The following factors can also create massive and detrimental disruptions in normal blood flow to the spleen and other organs: benign hematological disorders, taking oral contraceptives, lupus anticoagulants, idiopathic venous thrombosis, undergoing erythroprotein therapy, sickle hemoglobinopathies, and polycythemia.
• Sickle cell diseases that result in splenic infarctions can also lead to an inactive or non-functioning spleen, known as autosplenectomy.
• Aortic dissection, blunt forces to the abdominal section, torsion of the splenic artery, and compression of the splenic artery caused by a tumor can all weaken the splenic artery and inevitably lead to splenic infarction.
• Complications following vascular procedures or heart surgery
• Diffuse intravascular coagulation or vasculitis
• Certain medications like vasoconstrictors can raise the propensity for the body to develop thrombosis or vasospasms, which both lead to splenic infarction.
• Granulomatosis and polyangiitis are both serious conditions that can disrupt or cut off the blood flow to various organs, including the spleen.
• Collagen vascular disease and autoimmune disorders can also have the same effect as the body mistakenly instructs antibodies to attack healthy cells and tissues that exist within organs and promote normal functionality.
• Vein thrombosis, amyloidosis, pancreatic, sarcoidosis, acute respiratory distress syndrome (ARDS) pancreatic cancer, and postpartum toxic shock syndrome are also well-known culprits.
• Medical causes of splenomegaly
• Certain surgical procedures like liver transplants and pancreatectomy also lead to decreased blood supply or impermeability to various organs including the spleen.

Complications of splenic infarction

Severe splenic infarction complications may require surgery, which is often used as a last resort by most physicians. Typically, laparoscopic surgery, also known as minimally invasive surgery, is implemented to remove either the entire organ or just the infarct portions of it to prevent further infection.

Complications related to splenic infarction include:

Splenic abscess

1. This is typically the result of splenic infarctions that are caused by harmful bacteria.
2. Symptoms include pain in the upper abdominal area, radiating or shooting shoulder pains, mild or extreme tenderness in the upper abdomen, pain on the left side of the lower chest, vomiting, nausea, fever, or a combination of all of the above.
3. If left untreated, a splenic abscess can lead to sepsis as the bacteria infiltrate the bloodstream and effectively spreads to other organs, tissues, and cells throughout the body, infecting them all. Untreated and undiagnosed sepsis can lead to septic shock, which is characterized by symptoms such as decreased mental capacity or functions and extreme hypotension.

Ruptured spleen

1. A non-traumatic ruptured spleen is difficult to diagnose right off the bat because it shares many of the same symptoms of appendicitis, acute pancreatitis, and heart attacks.
2. As a result, it’s often misdiagnosed until it progresses and becomes more problematic.
3. The most common symptom of a ruptured spleen is intense pain in the upper-left abdomen and this can eventually spread to the left shoulder.
4. Hypotension and tachycardia are also fairly common symptoms of a ruptured spleen, and these can indicate hemorrhagic shock.

What are the symptoms of splenic infarction?

The types and intensity of splenic infarction symptoms that patients are likely to experience generally depend on the severity and extent of the condition as well as the exact cause that lead to it. Keep in mind that in mild cases, this condition can be completely asymptomatic and many of these symptoms are also common among other illnesses, which makes it very difficult for doctors to accurately diagnose it.

These can include either one, all, or a combination of the following warning signs:

• Upper left abdominal pain
• Left flank pain
• Chest pain
• Tachycardia—a condition in which the heart rate accelerates to a much faster rate than the normal resting rate (anything over a resting heart rate of 100 beats per minute is considered excessive and a potential cause for concern)
• Abdominal distension—accumulation of gas or fluid in the abdomen that causes it to protrude outward far beyond the normal girth of the stomach
• Decreased mental functions or onset of mental illness as a result of possible septic shock
• Fever and chills coupled with nausea and vomiting

Diagnosing splenic infarction

As mentioned, splenic infarction is incredibly difficult to detect and diagnose based on the presentation of symptoms alone; sometimes even splenic infarction radiology or x-rays may not show sufficient or accurate images of its signs.

Splenic infarction diagnosis involves a multi-step process that includes the following practices:

• Thorough medical examination and history of the patient to guarantee the most accurate diagnosis and subsequent treatments
• Then a CT scan is performed to confirm the pre-diagnosis
• Your doctor will try to determine the source of your blood clot
• A complete blood count (CBC) is performed to verify that your bloodstream is operating as it should
• Comprehensive metabolic panel (CMP)
• Magnetic resonance imaging (MRI)
• Angiography

Prognosis and treatment of splenic infarction

Often, a splenic infarction is an indication of a potentially more serious underlying medical issue that may be plaguing the body. With that in mind, the main point of treatment is to identify the underlying medical problem and effectively remedying it as quickly as possible.

As a result, there’s no specific treatment method that can be applied to cure splenic infarction. Doctors spend a great deal of time observing their patients and the symptoms they’re experiencing as a means of better identifying the fundamental cause and source of the splenic infarction. They also administer strong painkillers to ensure that the treatment process is as painless and comfortable as possible for the patient.

A splenectomy (surgical procedure in which either the infarct portion of the spleen or the entire spleen is removed) is typically used as a last resort treatment method if the damage is substantial to the point where there’s no chance of curing or healing it. This is usually only the case when complications occur as a direct result of splenic infarction as removing the spleen greatly increases the risk of serious infections occurring throughout the body.

Splenic infarction prognosis depends largely on the fundamental cause of the condition. In mild cases where either very few or no symptoms are present or obvious, the chances of survival are much higher as this usually means the underlying physical ailment most likely isn’t that serious or it hasn’t progressed to the point of becoming untreatable or fatal.

Sometimes, splenic infarction is purposely induced as a treatment method for other medical ailments such as portal hypertension or damages to the spleen. With that said, if you suffer from a specific medical condition or illness that increases your risk of enduring an organ infarction of any kind, particularly the spleen, then it’s important that you seek treatment immediately as the condition could rapidly worsen.

Initially, your doctor will keep you under constant supervision to ensure that they can identify the causative condition and stabilize or treat it before it becomes completely untreatable or inoperable. Many of these conditions can quickly become fatal, so early detection and diagnosis are imperative for an optimistic prognosis.

Related: Enlarged spleen (splenomegaly) causes, symptoms, spleen pain and treatment