Seeger M, Fölsch U R
I. Medizinische Klinik für Allgemeine Innere Medizin, Universitätsklinikum Schleswig-Holstein, Campus Kiel.
Dtsch Med Wochenschr. 2004 Apr 16;129(16):876-9. doi: 10.1055/s-2004-823033.
A 35-year-old patient with known mitral valve endocarditis presented with a stabbing pain in the left upper abdomen (patient 1). A 79-year-old patient with a history of chronic lymphocytic leukaemia (CLL) and aortic valve replacement presented with acute left upper quadrant, chest pain and impaired vision (patient 2).
An abdominal ultrasound revealed nonhomogeneous hypoechoic splenic lesions in both patients, which were classified as extended splenic infarctions by echo enhancer studies. The diagnosis was confirmed by computed tomography. Transesophageal echocardiography showed extensive mitral valve vegetations in patient 1. Patient 2 had a progression of the CLL without evidence of endocarditis. Magnetic resonance imaging of the brain showed infarction of the posterior cerebral artery area.
DIAGNOSIS, TREATMENT AND COURSE: Patient 1: Mitral valve endocarditis with embolic splenic infarction. Patient 2: Progressive CLL with thrombotic splenic and brain infarction. In patient 1, mitral valve replacement was performed. In patient 2, chemotherapy was initiated and she was started on low molecular weight heparin s. c. and aspirin. No further embolic or thrombotic complications occurred. No splenectomy was performed.
A splenic infarction is a complication pointing towards an underlying serious disorder. Echo-enhanced ultrasound is as sensitive as computed tomography for early diagnosis. Splenic infarction should trigger urgent treatment of the underlying condition.
一名35岁已知患有二尖瓣心内膜炎的患者出现左上腹刺痛（患者1）。一名79岁有慢性淋巴细胞白血病（CLL）病史且接受过主动脉瓣置换术的患者出现左上腹急性疼痛、胸痛和视力障碍（患者2）。
腹部超声显示两名患者脾脏均有不均匀低回声病变，经回声增强剂检查分类为广泛性脾梗死。计算机断层扫描确诊。经食管超声心动图显示患者1二尖瓣有广泛赘生物。患者2的CLL病情进展，无感染性心内膜炎证据。脑部磁共振成像显示大脑后动脉区域梗死。
诊断、治疗与病程：患者1：二尖瓣心内膜炎伴栓塞性脾梗死。患者2：进行性CLL伴血栓形成性脾梗死和脑梗死。患者1接受了二尖瓣置换术。患者2开始化疗，并皮下注射低分子量肝素和服用阿司匹林。未发生进一步的栓塞或血栓形成并发症。未行脾切除术。
脾梗死是一种提示潜在严重疾病的并发症。超声增强检查与计算机断层扫描对早期诊断同样敏感。脾梗死应促使对潜在疾病进行紧急治疗。
