a Department of Internal Medicine B , Meir Medical Center , Kfar Saba , Israel.
b Sackler School of Medicine , Tel Aviv University , Tel-Aviv , Israel.
Ann Med. 2018 Sep;50(6):494-500. doi: 10.1080/07853890.2018.1492148. Epub 2018 Jul 31.
There are insufficient data on the aetiologic factors underlying splenic infarction (SI). Therefore, there is no consensus regarding the appropriate diagnostic approach.
We conducted a retrospective analysis of all patients admitted with SI from January 2004 to December 2014. Medical records were screened for the clinical presentation, underlying causes, associated medical conditions and methods of patient evaluation.
We found 89 subjects with 90 episodes of SI. Presentation of SI was characterized by abdominal, flank and chest pain (82.2%, 18.9%, 7.8%, respectively); leukocytosis (in 67% of tested subjects); elevated LDH (72%), CRP (97.5%) and D-Dimer (100%). The main underlying mechanisms were cardioembolic (54.4%), vascular (20%), haematologic disorders (15.6%) and multiple causes (21.1%). Atrial fibrillation and atherosclerosis were common in older patients (age > 70 years) while antiphospholipid syndrome occurred exclusively in younger individuals. SI was the presentation of previously unknown medical conditions in 38% of patients. Abdominal CT, ECG, echocardiography and blood cultures demonstrated the highest diagnostic yield.
Contributing factors are identified in the majority of SI patients. We recommend CT, ECG, echocardiography and blood cultures in all cases. Atrial fibrillation should be sought in older patients, while APLS and haematologic disorders should be suspected in younger ones. KEY MESSAGES There is no consensus regarding the diagnostic approach and management of splenic infarction. Cardiovascular disease and atrial fibrillation are the main causes for SI in elderly subjects while hematological, infectious and other causes are more prevalent in younger ones. Our data strongly suggests a high diagnostic yield for CT scan, ECG, blood culture and echocardiogram in every patient with SI.
目前关于脾梗死（SI）的病因因素的数据不足。因此，对于合适的诊断方法尚未达成共识。
我们对 2004 年 1 月至 2014 年 12 月期间因 SI 住院的所有患者进行了回顾性分析。对病历进行了筛选，以确定临床表现、潜在病因、相关医疗条件和患者评估方法。
我们共发现 89 例患者 90 个脾梗死发作。脾梗死的表现为腹痛、腰痛和胸痛（分别为 82.2%、18.9%、7.8%）；白细胞增多（在 67%的检测患者中）；乳酸脱氢酶（72%）、C 反应蛋白（97.5%）和 D-二聚体（100%）升高。主要的潜在机制是心源性栓塞（54.4%）、血管性（20%）、血液学疾病（15.6%）和多种原因（21.1%）。年龄大于 70 岁的患者中常见房颤和动脉粥样硬化，而抗磷脂综合征仅发生在年轻患者中。38%的患者脾梗死是之前未知的医疗条件的表现。腹部 CT、心电图、超声心动图和血培养显示出最高的诊断效果。
大多数脾梗死患者都能确定病因。我们建议所有病例都进行 CT、心电图、超声心动图和血培养检查。老年患者应寻找房颤，而年轻患者应怀疑抗磷脂综合征和血液系统疾病。关键信息：目前关于脾梗死的诊断方法和治疗方法尚未达成共识。心血管疾病和房颤是老年患者发生脾梗死的主要原因，而血液系统、感染和其他原因在年轻患者中更为常见。我们的数据强烈表明，每例脾梗死患者的 CT 扫描、心电图、血培养和超声心动图都具有较高的诊断效果。
