what do you notice on her CT?
Our patient had a splenic infarct. Splenic infarct occurs when one of the branches of the splenic artery is occluded or there is venous congestion with ischemia. The complications include: a ruptured spleen , bleeding, pseudocyst or abscess.
CAUSES OF SPLENIC INFARCTION
Splenomegaly- Splenic infarct is more common in hematological disorders associated with splenomegaly like myeloproliferative disorders. Splenomegaly caused by storage diseases like Gaucher’s can also result in infarct. Probably the most common cause of splenic infarct is sickle cell disease where autosplenectomy occurs over time.
Splenic infections such as mono, cmv, malaria and babesiosis are associated with splenic infarcts. Hypercoagulable states such as malignancy , antiphospholipid syndrome or factor V Leiden may also result in splenic infarcts. The infarcts can also be embolic associated with endocarditis or a fib.
Any compromise of the splenic artery can result in infarction including aortic dissection, external compression by a tumor or torsion of the splenic artery
Vasculitis and DIC are also associated with infarcts. In patients with cancer a “vascular syndrome” has been described in patients receiving angiogenesis inhibitors like bevacizumab. Immediately following initiation of treatment; strokes, MIs , PEs and splenic infarcts have been reported.
Our patient had cancer which is known to cause a hypercoagulable state. Decreased protein C, protein S, and antithrombin, activation of factor X, and increased platelet catabolism all have been implicated in thrombogenesis in cancer patients.
In our patient, coagulation studies were normal, embolic disease was ruled out with a normal cardiac echo. Blood cultures showed no growth. It was assumed that her infarct was due to splenomegaly and her malignancies causing a hypercoagulable state.
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