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Grishin E, Soudack M, Levy-Mendelovich S, Bezalel Y, Lubetsky A, Cohen O, Brutman-Barazani T, Efros O, Kenet G, Barg AA. Pediatric splenic infarction: Assessment of associated clinical conditions and outcome. Pediatr Blood Cancer 2024; 71:e30939. [PMID: 38462782 DOI: 10.1002/pbc.30939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Revised: 02/14/2024] [Accepted: 02/22/2024] [Indexed: 03/12/2024]
Abstract
Pediatric splenic infarction (SI) is rare yet clinically significant. Publications regarding this complication are mostly limited to case reports. This is a retrospective study examining SI etiology, clinical presentation, management, and outcomes among children. Twenty-two patients (median age: 7.9 years) were included, mostly with pre-existing hematological diseases. Splenomegaly (72%), thrombocytopenia, and anemia were common. Most of the patients did not receive antithrombotic therapy yet only two patients experienced recurrences. During follow up 36% of patients died, however no fatalities were attributed to thrombotic or bleeding complications.
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Affiliation(s)
- Evgeny Grishin
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Michalle Soudack
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Pediatric Imaging Unit, Sheba Medical Center, Ramat Gan, Israel
| | - Sarina Levy-Mendelovich
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- National Hemophilia Center, Coagulation Unit and Amalia Biron Research Institute of Thrombosis and Hemostasis, Sheba Medical Center, Ramat Gan, Israel
- Talpiot Sheba Leadership Program, Sheba Medical Center, Ramat Gan, Israel
| | - Yael Bezalel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Pediatric Pulmonology and National CF Center, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel-Hashomer, Israel
| | - Aharon Lubetsky
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- National Hemophilia Center, Coagulation Unit and Amalia Biron Research Institute of Thrombosis and Hemostasis, Sheba Medical Center, Ramat Gan, Israel
| | - Omri Cohen
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- National Hemophilia Center, Coagulation Unit and Amalia Biron Research Institute of Thrombosis and Hemostasis, Sheba Medical Center, Ramat Gan, Israel
| | - Tami Brutman-Barazani
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- National Hemophilia Center, Coagulation Unit and Amalia Biron Research Institute of Thrombosis and Hemostasis, Sheba Medical Center, Ramat Gan, Israel
| | - Orly Efros
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- National Hemophilia Center, Coagulation Unit and Amalia Biron Research Institute of Thrombosis and Hemostasis, Sheba Medical Center, Ramat Gan, Israel
| | - Gili Kenet
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- National Hemophilia Center, Coagulation Unit and Amalia Biron Research Institute of Thrombosis and Hemostasis, Sheba Medical Center, Ramat Gan, Israel
| | - Assaf A Barg
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- National Hemophilia Center, Coagulation Unit and Amalia Biron Research Institute of Thrombosis and Hemostasis, Sheba Medical Center, Ramat Gan, Israel
- Departmnet of Pediatric Hematology-Oncology, The Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Ramat Gan, Israel
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2
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Lin JW, Chen CT, Kuo Y, Jeng MJ, How CK, Huang HH. Risk factors for mortality among patients with splenic infarction in the emergency department. J Formos Med Assoc 2024:S0929-6646(24)00246-8. [PMID: 38763857 DOI: 10.1016/j.jfma.2024.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Revised: 04/27/2024] [Accepted: 05/14/2024] [Indexed: 05/21/2024] Open
Affiliation(s)
- Jin-Wei Lin
- Department of Emergency Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Emergency and Critical Care Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Chung-Ting Chen
- Department of Emergency Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Institute of Health Policy and Management, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Yu Kuo
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Nuclear Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Mei-Jy Jeng
- Institute of Emergency and Critical Care Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chorng-Kuang How
- Department of Emergency Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Emergency and Critical Care Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Hsien-Hao Huang
- Department of Emergency Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Emergency and Critical Care Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
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3
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Wyttynck A, Bismut M, Belhomme N, Perlat A, Ballerie A, Lescoat A. [The causes of splenic infarction: An almost systematic review of the literature]. Rev Med Interne 2024; 45:264-270. [PMID: 38538435 DOI: 10.1016/j.revmed.2024.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 03/05/2024] [Accepted: 03/05/2024] [Indexed: 06/07/2024]
Abstract
INTRODUCTION Splenic infarction is a rare event in clinical practice, diagnosed by CT scan. There are many causes. They often determine the treatment given. However, there is no consensus on etiological investigations. METHODS We present here an almost systematic review of the literature, based on data available on Pubmed from 1991 to 2022. Using the keywords "splenic infarct", from 1893 references, 11 cohort studies and 867 clinical cases were included in this review. Articles written in languages using alphabets other than Latin were excluded. RESULTS AND CONCLUSIONS Analysis of these various studies has enabled us to draw up a list that is intended to be as exhaustive as possible of the causes of splenic infarction. The most frequent are emboligenic heart disease, hematological malignancies, solid neoplasia and certain infections. The descriptions available in the literature were mainly based on isolated clinical cases, not always making it possible to establish a causal link with the disease described, especially as around 20% of reported cases of splenic infarction were asymptomatic and potentially of incidental discovery. Based on the findings of this literature review, we propose a protocol for the etiological assessment of splenic infarcts.
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Affiliation(s)
- A Wyttynck
- Service de médecine interne et immunologie clinique, CHU de Rennes, 16, boulevard de Bulgarie, 35203 Rennes, France.
| | - M Bismut
- Eugène Marquis, avenue de la Bataille de Flandres-Dunkerque, cs 44229, 35000 Rennes, France
| | - N Belhomme
- Service de médecine interne et immunologie clinique, CHU de Rennes, 16, boulevard de Bulgarie, 35203 Rennes, France
| | - A Perlat
- Service de médecine interne et immunologie clinique, CHU de Rennes, 16, boulevard de Bulgarie, 35203 Rennes, France
| | - A Ballerie
- Service de médecine interne et immunologie clinique, CHU de Rennes, 16, boulevard de Bulgarie, 35203 Rennes, France
| | - A Lescoat
- Service de médecine interne et immunologie clinique, CHU de Rennes, 16, boulevard de Bulgarie, 35203 Rennes, France
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Moin K, Al-Neyadi M, Iqbal T, Jaiganesh T. Splenic Infarct Masquerading as Myocardial Infarction. Cureus 2024; 16:e60138. [PMID: 38864068 PMCID: PMC11165438 DOI: 10.7759/cureus.60138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/12/2024] [Indexed: 06/13/2024] Open
Abstract
Splenic infarction is an uncommon cause of abdominal pain. Diabetes increases the risk of blood vessel occlusion and consequent tissue infarction due to blood vessel abnormalities such as atherosclerosis or thrombosis. Systemic thromboembolism secondary to myocardial infarction is associated with an increased risk of morbidity and mortality. We report the case of a 45-year-old woman with uncontrolled diabetes who presented to the emergency department with the sole complaint of left upper quadrant pain. Upon investigations, it was discovered that she had concomitant splenic and myocardial infarctions. This case demonstrates the significance of thrombotic complications in various organs in patients with uncontrolled diabetes mellitus. Clinicians should have a high suspicion of acute vascular infarction of several organs in poorly controlled diabetic patients with nonspecific symptoms.
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Affiliation(s)
- Kinza Moin
- Emergency Department, Tawam Hospital, Al Ain, ARE
| | | | - Tarab Iqbal
- Emergency Department, Tawam Hospital, Al Ain, ARE
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Fukushima A, Kobayashi T, Otsuka Y, Hosokawa N, Moody S, Takagi M, Yoshida A. A case of prosthetic valve endocarditis and aortic abscess due to Bacillus cereus. IDCases 2024; 36:e01940. [PMID: 38681080 PMCID: PMC11046206 DOI: 10.1016/j.idcr.2024.e01940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2024] [Accepted: 04/12/2024] [Indexed: 05/01/2024] Open
Abstract
Bacillus cereus (B. cereus) is commonly found in the environment and is often considered a blood culture contaminant. However, in patients with specific risk factors such as intravenous drug use, central venous access catheters, immunosuppression, or prosthetic valves, B. cereus can cause severe infections. Herein, we present a case of prosthetic valve endocarditis (PVE) caused by B. cereus in an 84-year-old woman with a history of aortic valve replacement for aortic stenosis five years earlier. She presented with anorexia, and her physical examination revealed tenderness in the left upper quadrant of the abdomen. Blood culture grew B. cereus, and a CT scan showed splenic infarction, raising suspicion of PVE. Transesophageal echocardiogram (TEE) revealed an abscess around the left coronary cusp of the aortic valve and a 15 mm vegetation. Due to the patient's high risk for post-operative complications and her unwillingness to undergo surgery, the surgery was deferred. Instead, she was successfully treated with six weeks of intravenous vancomycin and discharged home. Follow-up TEE demonstrated resolution of the vegetation and valvular abscess. At her six-month post-discharge evaluation, no signs of active infection were noted including fever or worsening heart failure. Although surgery is typically recommended for most cases of PVE, conservative treatment can be considered as an alternative option for selected patients.
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Affiliation(s)
- Akina Fukushima
- Department of General Internal Medicine, Kameda Medical Center, Kamogawa, Chiba, Japan
- Department of Infectious Diseases, Maebashi Red Cross Hospital, Maebashi, Gunma, Japan
| | - Takaaki Kobayashi
- Division of Infectious Diseases, University of Iowa, Iowa City, Iowa, USA
| | - Yoshihito Otsuka
- Department of Clinical Laboratory, Kameda Medical Center, Kamogawa, Chiba, Japan
| | - Naoto Hosokawa
- Department of Infectious Diseases, Kameda Medical Center, Kamogawa, Chiba, Japan
| | - Sandra Moody
- Department of Medicine, Divisions of Hospital Medicine & Geriatrics, University of California, San Francisco, USA
| | - Miyu Takagi
- Department of General Internal Medicine, Kameda Medical Center, Kamogawa, Chiba, Japan
| | - Akihito Yoshida
- Department of General Internal Medicine, Kameda Medical Center, Kamogawa, Chiba, Japan
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6
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Ho YR, Tsai TY, Jhan JY. A Man With Left Upper Quadrant Pain. Ann Emerg Med 2024; 83:409-410. [PMID: 38519206 DOI: 10.1016/j.annemergmed.2023.10.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Accepted: 10/30/2023] [Indexed: 03/24/2024]
Affiliation(s)
- Yan-Rong Ho
- School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Tou-Yuan Tsai
- School of Medicine, Tzu Chi University, Hualien, Taiwan; Emergency Department, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan
| | - Jin-You Jhan
- Division of Cardiovascular Surgery, Department of Surgery, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan; Department of Surgery, School of Medicine, Tzu Chi University, Hualien, Taiwan
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7
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Wildman EC, Brockman N, Meatherall BL. A case report of Capnocytophaga canimorsus meningitis with failure of ceftriaxone therapy. JOURNAL OF THE ASSOCIATION OF MEDICAL MICROBIOLOGY AND INFECTIOUS DISEASE CANADA = JOURNAL OFFICIEL DE L'ASSOCIATION POUR LA MICROBIOLOGIE MEDICALE ET L'INFECTIOLOGIE CANADA 2024; 9:46-51. [PMID: 38567365 PMCID: PMC10984312 DOI: 10.3138/jammi-2023-0003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 10/18/2023] [Accepted: 10/20/2023] [Indexed: 04/04/2024]
Abstract
Background Capnocytophaga canimorsus is a gram-negative zoonotic organism that has the potential to cause devastating human infection. Historically, treatment with beta-lactams including penicillin and ceftriaxone has been effective. Methods We describe a complicated case of C. canimorsus meningitis in a 70-year-old female following a superficial puncture wound from her dog's teeth. Results The case described here was complicated by seizures following treatment with ceftriaxone therapy. This case is also the first reported case of C. canimorsus meningitis associated with moyamoya disease and fibromuscular dysplasia. Conclusions Physicians should be aware of the possibility of ceftriaxone-resistant C. canimorsus and have a low threshold to broaden antimicrobial coverage in the absence of clinical improvement. We also raise the possibility of an association between vasculopathies and unusual infections like C. canimorsus.
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Affiliation(s)
- Emily C Wildman
- Department of Medicine, University of Western Ontario, London, Ontario, Canada
| | - Nicole Brockman
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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8
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Baroudi MMHD, Kamal sabra M, Abuzaid H, Alhussein H, Alkhalaila O, Habib MB. Subacute infective endocarditis presenting with an isolated splenic infarction. IDCases 2023; 32:e01752. [PMID: 37063782 PMCID: PMC10090703 DOI: 10.1016/j.idcr.2023.e01752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 03/22/2023] [Accepted: 03/28/2023] [Indexed: 03/31/2023] Open
Abstract
Background Subacute endocarditis usually presents over a period of weeks or months. Symptoms usually include low grade fever, and generalized symptoms of malaise, anorexia, weight loss. Here we present a case of subacute endocarditis presenting solely as acute left hypochondrial pain, which was found to be splenic infarct. Typical symptoms of subacute endocarditis were absent in our patient. Case report A 48-year-old Yemeni gentleman presented to the emergency department with acute and severe left hypochondrial abdominal pain for a few hours. Blood investigations revealed normal blood count differential, renal, liver function, and electrolyte levels. CT abdomen with contrast showed large focal wedge-shaped splenic lesion representing splenic infarct. Initial workup was negative for an underlying etiology. TEE showed a spherical mobile mass attached to the aortic valve with moderate to severe aortic regurgitation. Subsequently, 3 sets of blood cultures were sent and revealed growth of streptococcus viridians in all bottles. The patient received IV antibiotics as a treatment of endocarditis. Conclusion This case highlights how subacute endocarditis presented as splenic infarction, with the absence of the typical infectious symptoms. In case of splenic infarction with unclear source or etiology, it is reasonable to investigate thoroughly for infective endocarditis preferably with TEE.
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9
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Sarmadian R, Ghasemikhah R, Sarmadian H, Khosravi M, Hassani S. Post‐
COVID
‐19 splenic infarction in a patient with chronic atrial fibrillation: A case report. Clin Case Rep 2022; 10:e6011. [PMID: 35846926 PMCID: PMC9272218 DOI: 10.1002/ccr3.6011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 05/30/2022] [Accepted: 06/12/2022] [Indexed: 11/30/2022] Open
Abstract
We describe splenic infarction (SI), an infrequent condition, in an 82‐year‐old COVID‐19 patient with chronic atrial fibrillation (AF). COVID‐19 may cause thrombosis, and AF is a predisposing factor for splenic infarction. Suspicion of SI may be warranted in COVID‐19 patients with abdominal pain, especially if a predisposing factor exists.
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Affiliation(s)
- Roham Sarmadian
- Department of Infectious Diseases, School of Medicine Arak University of Medical Sciences Arak Iran
| | - Reza Ghasemikhah
- Department of Parasitology and Mycology, School of Medicine Arak University of Medical Sciences Arak Iran
| | - Hossein Sarmadian
- Department of Infectious Diseases, School of Medicine Arak University of Medical Sciences Arak Iran
| | - Mahmood Khosravi
- Department of Medical Laboratory Sciences, School of Allied Medical Sciences Arak University of Medical Sciences Arak Iran
| | - Saeed Hassani
- Department of Medical Laboratory Sciences, School of Allied Medical Sciences Arak University of Medical Sciences Arak Iran
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10
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Abdominal Pain at an Altitude. Am J Med 2022; 135:459-460. [PMID: 34560036 DOI: 10.1016/j.amjmed.2021.08.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 08/23/2021] [Indexed: 11/23/2022]
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11
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Javaid U, Young P, Gill G, Bhargava P. Acute complete splenic infarction secondary to COVID-19 infection. Radiol Case Rep 2022; 17:1402-1406. [PMID: 35242265 PMCID: PMC8889326 DOI: 10.1016/j.radcr.2022.02.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 01/28/2022] [Accepted: 02/02/2022] [Indexed: 12/23/2022] Open
Abstract
Splenic infarction in COVID-19 patients is a rare entity with few documented cases. We report a case of symptomatic complete splenic infarction and discuss COVID-19 related thrombosis, splenic infarction, diagnostic imaging for splenic infarction, and the management. Thrombotic events related to COVID-19 have been reported in unusual locations, and our case highlights an example of one such location, the splenic artery. Contrast enhanced Computed Tomography (CT) is the standard diagnostic modality and will typically reveal foci of hypo-enhancement, peripheral and wedge-shaped. CT angiography can be performed to evaluate the arteries and diagnose thrombosis. The primary treatment is aimed at addressing the underlying cause and includes supportive care. It is important that physicians consider splenic infarction as an explanation for abdominal pain in COVID-19 patients.
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12
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Janga C, Okoyeze K, Chan V. Isolated Splenic Infarction: An Initial Manifestation of Postoperative Atrial Fibrillation. J Investig Med High Impact Case Rep 2022; 10:23247096221103384. [PMID: 35699230 PMCID: PMC9201299 DOI: 10.1177/23247096221103384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Splenic infarction is an uncommon cause of abdominal pain. In this article, we present a
case of isolated splenic infarction presenting with severe abdominal pain, nausea, and
with associated generalized weakness. Computed tomography (CT) abdomen and pelvis with
contrast revealed multiple splenic infarctions of the entire lower pole with occlusion of
the branch splenic arteries, while CT abdomen without contrast was unremarkable. Etiology
was later revealed to be thromboembolism secondary to atrial fibrillation. It was managed
with anticoagulation. To our knowledge, this is the second case of splenic infarction
presenting as an initial manifestation of atrial fibrillation (AF), reported in the
literature.
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Affiliation(s)
- Chaitra Janga
- Department of Internal Medicine, Jefferson Health–Abington, PA, USA
| | | | - Vincent Chan
- Department of Pulmonary and Critical Care, Thomas Jefferson University, Philadelphia, PA, USA
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13
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Yen CC, Wang CK, Chaou CH, Chen SY, Lin JP, Ng CJ. Anticoagulant Therapy Is Associated With Decreased Long-Term Mortality in Splenic Infarction Patients: A Multicenter Study. Front Med (Lausanne) 2021; 8:778198. [PMID: 34912831 PMCID: PMC8666632 DOI: 10.3389/fmed.2021.778198] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 11/09/2021] [Indexed: 12/31/2022] Open
Abstract
Background: Patients with splenic infarction (SI) are associated with a prothrombotic state and are vulnerable to subsequent thromboembolic complications. However, due to its rarity, there is no established treatment modality in this population. We aimed to examine the effect of anticoagulant therapy in SI patients. Methods: We performed a multicenter retrospective cohort study of 86 SI patients. Patients were categorized as anticoagulant users and anticoagulant non-users. The associations between anticoagulant therapy, all-cause mortality, thromboembolic events and bleeding events were evaluated. Results: Forty-five patients (52.3%) received anticoagulant therapy during the follow-up periods. The all-cause mortality rate was 6.86 per 100 patient-years. Anticoagulant therapy was associated with 94% improved survival (HR = 0.06; Cl 0.007–0.48; p = 0.008), while the risk factors for all-cause mortality were prior stroke (HR = 13.15; Cl 2.39–72.27; p = 0.003) and liver cirrhosis (HR = 8.71; Cl 1.29–59.01; p = 0.027). Patients with anticoagulant therapy had a higher event-free survival curve for thromboembolic complications (p = 0.03) but did not achieve a significant difference after adjustment using the Cox regression model as a time-dependent covariate (HR = 0.57; Cl 0.13–2.45; p = 0.446). There was no significant difference in the risk of bleeding events between the groups (p = 0.728). Conclusions: Anticoagulant therapy in patients with SI was associated with better survival and was not related to an increased bleeding risk.
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Affiliation(s)
- Chieh-Ching Yen
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,College of Medicine, National Yang Ming University, Taipei, Taiwan
| | - Chih-Kai Wang
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chung-Hsien Chaou
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Chang Gung Medical Education Research Center, Taoyuan, Taiwan
| | - Shou-Yen Chen
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Chang Gung Medical Education Research Center, Taoyuan, Taiwan
| | - Jhe-Ping Lin
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chip-Jin Ng
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
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14
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May JE. Unexplained arterial thrombosis: approach to diagnosis and treatment. HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2021; 2021:76-84. [PMID: 34889390 PMCID: PMC8791102 DOI: 10.1182/hematology.2021000235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Arterial thrombotic events in younger patients without a readily apparent etiology present significant diagnostic and management challenges. We present a structured approach to diagnosis with consideration of common causes, including atherosclerosis and embolism, as well as uncommon causes, including medications and substances, vascular and anatomic abnormalities, systemic disorders, and thrombophilias. We highlight areas of management that have evolved within the past 5 years, including the use of dual-pathway inhibition in atherosclerotic disease, antithrombotic therapy selection in embolic stroke of undetermined source and left ventricular thrombus, the role of closure of patent foramen ovale for secondary stroke prevention, and the thrombotic potential of coronavirus disease 2019 infection and vaccination. We conclude with a representative case to illustrate the application of the diagnostic framework and discuss the importance of consideration of bleeding risk and patient preference in determining the appropriate management plan.
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Affiliation(s)
- Jori E. May
- Department of Medicine, Division of Hematology/Oncology, University of Alabama at Birmingham, Birmingham, AL
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15
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Risk assessment and prognostic analysis of patients with splenic infarction in emergency department: a multicenter retrospective study. Sci Rep 2021; 11:21423. [PMID: 34728700 PMCID: PMC8564514 DOI: 10.1038/s41598-021-00897-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 10/07/2021] [Indexed: 01/18/2023] Open
Abstract
Splenic infarction is a thromboembolic disease that is frequently missed in acute settings. Previous reviews were rarely presented from a clinical perspective. We aimed to evaluate the clinical characteristics, risk factors with diagnostic value, and prognostic factors using large cohort data and a matched case–control study method. A retrospective medical record review of six hospitals in Taiwan from January 1, 2005, to August 31, 2020, was conducted. All patients who underwent contrast CT with confirmed the diagnosis of splenic infarction were included. Their characteristics were presented and compared to a matched control group with similar presenting characteristics. Prognostic factors were also analyzed. A total of 130 cases were included, two-thirds of whom presented with abdominal pain. Atrial fibrillation was the most common associated predisposing condition, followed by hematologic disease. A higher proportion of tachycardia, positive qSOFA score, history of hypertension or atrial fibrillation, leukocytosis, and thrombocytopenia were found in splenic infarction patients compared to their counterparts. An underlying etiology of infective endocarditis was associated with a higher proportion of ICU admission. Splenic infarction patients often presented with left upper abdominal pain and tachycardia. A history of hypertension, atrial fibrillation, a laboratory result of leukocytosis or thrombocytopenia may provide a clue for clinicians to include splenic infarction in the differential list. Among the patients diagnosed with splenic infarction, those with an underlying etiology of infectious endocarditis may be prone to deterioration or ICU admission.
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16
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Splenic infarction with aortic thrombosis in COVID-19. Am J Med Sci 2021; 362:418-423. [PMID: 34161825 PMCID: PMC8214812 DOI: 10.1016/j.amjms.2021.06.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 05/23/2021] [Accepted: 06/18/2021] [Indexed: 12/30/2022]
Abstract
Coronavirus disease 2019 (COVID-19) has been associated with an increased risk of venous and arterial thrombotic disease. Although pulmonary embolism has been the most common thrombotic complication, there have been recent reports of COVID-19-associated large-vessel ischemic stroke, acute upper- and lower-limb ischemia, as well as infarctions of the abdominal viscera, including renal, splenic, and small bowel infarctions. Here, we describe a case of splenic infarction (SI) associated with aortic thrombosis, which evolved despite the prophylactic use of low-molecular-weight heparin (LMWH), in a 60-year-old female patient with COVID-19. The patient was treated clinically with a therapeutic dose of LMWH, followed by warfarin, and eventually presented a favorable outcome. We also present a review of the literature regarding SI in patients with COVID-19.
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Alejandre-de-Oña Á, Alonso-Muñoz J, Demelo-Rodríguez P, Del-Toro-Cervera J, Galeano-Valle F. COVID-19 as a trigger for splenic infarction in a patient with sickle cell trait: A case report. THROMBOSIS UPDATE 2021; 3:100047. [PMID: 38620776 PMCID: PMC7986315 DOI: 10.1016/j.tru.2021.100047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 02/20/2021] [Accepted: 03/18/2021] [Indexed: 11/16/2022] Open
Abstract
Sickle cell trait (SCT) is the carrier state for sickle cell disease (SCD) and is usually perceived as a mild condition; however, previous studies have shown that hypoxemia may trigger sickle-cell related complications in these patients, including splenic infarction. Hypoxemia is a common finding in patients with COVID-19 pneumonia. We present the case of a 19-year-old male with a history of epilepsy who presented to the emergency room due to abdominal pain in the left flank that appeared after presenting generalized tonic-clonic seizures and fever. SARS-CoV-2 RT-PCR testing in nasopharyngeal swab was positive and an abdominal computerized tomography (CT) revealed a massive splenic infarction. Hemoglobinopathy study using high-efficiency liquid chromatography demonstrated the presence of 39.7% HbS, thus confirming the diagnosis of SCT. Hypoxemia, endothelial dysfunction and hypercoagulability caused by SARS-CoV-2 infection could lead to complement activation and microangiopathy, triggering the vaso-occlusive crisis that led to splenic infarction.
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Affiliation(s)
- Álvaro Alejandre-de-Oña
- Venous Thromboembolism Unit, Internal Medicine, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Jaime Alonso-Muñoz
- Venous Thromboembolism Unit, Internal Medicine, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Pablo Demelo-Rodríguez
- Venous Thromboembolism Unit, Internal Medicine, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Department of Medicine, School of Medicine, Universidad Complutense de Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Jorge Del-Toro-Cervera
- Venous Thromboembolism Unit, Internal Medicine, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Department of Medicine, School of Medicine, Universidad Complutense de Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Francisco Galeano-Valle
- Venous Thromboembolism Unit, Internal Medicine, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Department of Medicine, School of Medicine, Universidad Complutense de Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
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Infectious Mononucleosis Complicated with Bilateral Peritonsillar Abscess and Splenic Infarction. Case Rep Infect Dis 2021; 2021:6623834. [PMID: 33777464 PMCID: PMC7979303 DOI: 10.1155/2021/6623834] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 02/27/2021] [Accepted: 03/06/2021] [Indexed: 01/20/2023] Open
Abstract
Infectious mononucleosis (IM) due to Epstein–Barr virus (EBV) infection is usually self-limited. It presents with fever, pharyngitis, fatigue, and cervical lymph node enlargement. It is common among adolescents and young adults. Although most patients recovered without any sequelae, rare complications have been reported. We described a 28-year-old man with fever, sore throat, dysphagia, and a positive IgM viral capsid Ag (VCA Ag) for EBV infection. He was admitted and received dexamethasone. He developed bilateral peritonsillar abscess (PTA) and splenic infarction, rare complications of acute EBV infection, two days after discharge. Although early reports noted PTA might occur following dexamethasone administration, recently, no obvious evidence supports it. However, high erythrocyte sedimentation rate level in our patient might indicate bacterial superinfection, which could exacerbate with dexamethasone administration. Several mechanisms such as transient hypercoagulable state and insufficient blood supply due to splenomegaly were proposed for splenic infarction due to EBV infection. Since our patient remained asymptomatic during the disease, IM-associated splenic complications, including splenic infarction, should be kept in mind. Our patient underwent bilateral tonsillectomy and received conservative management for the splenic infarction. These two rare complications of acute EBV infection have not been reported simultaneously yet.
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