Luncă S, Păduraru D, Romedea S N, Harutaka I, Moroşanu C
Universitatea de Medicină si Farmacie Gr T Popa Iaşi Facultatea de Medicină linica de Urgenţe Chirurgicale.
Rev Med Chir Soc Med Nat Iasi. 2008 Apr-Jun;112(2):416-21.
Splenic infarction is a very rare event though it can occur in a multitude of conditions with general or local manifestations. Splenic involvement in infectious endocarditis can be either infarction or abscess formation. The clinical picture is usually nonspecific and the diagnosis is often not initially suspected. We present a case of a 67 year-old male patient with infectious endocarditis who has been diagnosed with a splenic infarction by abdominal CT scan. The infarction was a result of septic embolization from the infected endocardium. The patient was initially managed conservatively with triple antibiotic therapy and regular follow-up ultrasound scan. The persistence of abdominal symptoms and the suspicion of splenic abscess formation led to the decision of performing splenectomy. Although imaging can characterize the nature of a splenic lesion, it is sometimes impossible to differentiate between infarction and abscess without histopathological confirmation. Splenic infarction should be suspected in all patients with a past history of thromboembolic disease who complain of left upper quadrant pain and present with localized or systemic inflammatory signs. Unfavorable clinical course and suspicion of abscess formation are indications for surgery. The characteristic features of splenic infarction are discussed together with a review of the recent literature.
脾梗死是一种非常罕见的情况，尽管它可发生于多种伴有全身或局部表现的病症中。感染性心内膜炎累及脾脏时，可为梗死或脓肿形成。临床表现通常不具特异性，诊断往往最初未被怀疑。我们报告一例67岁男性感染性心内膜炎患者，经腹部CT扫描诊断为脾梗死。该梗死是由感染性心内膜炎的脓毒性栓塞所致。患者最初采用三联抗生素治疗及定期超声随访进行保守治疗。腹部症状持续存在且怀疑形成脾脓肿，导致决定行脾切除术。尽管影像学可明确脾病变的性质，但有时在无组织病理学证实的情况下，无法区分梗死和脓肿。对于所有有血栓栓塞病史、主诉左上腹疼痛并伴有局部或全身炎症体征的患者，均应怀疑脾梗死。不良的临床病程及怀疑脓肿形成是手术指征。本文讨论了脾梗死的特征，并对近期文献进行了综述。
