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Splenic Infarction

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Splenic Infarction

Splenic infarction is the death of splenic tissue caused by interruption of its blood supply. It usually occurs due to arterial embolism, thrombosis, hematological disease, or a hypercoagulable state

Also called

Splenic ischemic infarction

ICD-10

D73.5

Specialty

Gastroenterology

Onset

Acute

Reviewed

July 2026

On This Page

Overview

  • Splenic infarction occurs when blood flow to part or all of the spleen is interrupted, causing ischemia and tissue necrosis. Patients commonly present with acute left upper-quadrant abdominal pain, sometimes radiating to the left shoulder. Contrast-enhanced CT is the preferred imaging test. Treatment mainly involves pain control and management of the underlying cause.

Etiology & Risk Factors

-Common Causes and Risk Factors

  • Atrial fibrillation

  • Infective endocarditis

  • Cardiac thromboembolism

  • Atherosclerotic embolism

  • Sickle cell disease

  • Polycythemia vera

  • Leukemia or lymphoma

  • Myeloproliferative disorders

  • Antiphospholipid syndrome

  • Factor V Leiden mutation

  • Protein C or protein S deficiency

  • Malignancy

  • Vasculitis

  • Splenic artery thrombosis

  • Pancreatitis

  • Abdominal trauma

  • Hypercoagulable states

Pathophysiology

Splenic arterial obstruction → reduced splenic blood flow → tissue ischemia → coagulative necrosis → local inflammation → left upper-quadrant pain and possible complications.

Clinical Presentation

    • Clinical Presentation

      • Sudden or persistent left upper-quadrant pain
      • Pain radiating to the left shoulder
      • Left upper-quadrant tenderness
      • Fever
      • Nausea or vomiting
      • Pleuritic left-sided chest pain
      • Abdominal guarding in severe cases
      • Some patients may be asymptomatic

History Taking

  • Ask about:

    • Onset, severity, and duration of abdominal pain
    • Radiation of pain to the left shoulder
    • Fever, chills, nausea, or vomiting
    • Previous thromboembolic events
    • Atrial fibrillation or valvular heart disease
    • Recent infection or infective endocarditis
    • Sickle cell disease or hematological disorders
    • Malignancy
    • Recent abdominal trauma
    • Use of anticoagulant medications
    • Personal or family history of thrombophilia

Physical Examination

  • General examination: Assess temperature, heart rate, blood pressure, hydration, pallor, and signs of sepsis or shock.Abdominal examination: Look for left upper-quadrant tenderness, guarding, rebound tenderness, abdominal distension, or splenomegaly.Cardiovascular examination: Assess for an irregular pulse, cardiac murmurs, or signs of infective endocarditis.Other examination: Look for signs of hematological disease, embolic phenomena, or underlying malignancy.

Investigations

-Laboratory Tests:

  • Complete blood count

  • C-reactive protein and ESR

  • Renal function and electrolytes

  • Liver function tests

  • Serum lactate

  • Coagulation profile

  • Blood cultures when fever or infective endocarditis is suspected

  • Peripheral blood smear

  • Thrombophilia testing in selected patients

  • ECG to detect atrial fibrillation

-Imaging:

  • Contrast-enhanced CT abdomen is the preferred investigation. It usually shows a peripheral, wedge-shaped, low-attenuation area within the spleen.
  • Abdominal ultrasound with Doppler may be used when CT is unavailable or contraindicated, but it is less sensitive during the early stage.
  • Echocardiography should be considered when a cardiac embolic source or infective endocarditis is suspected.

Diagnosis

-Diagnosis is based on :

  • compatible symptoms, risk factors, physical examination, and characteristic findings on contrast-enhanced CT.
  • The underlying cause should also be identified because splenic infarction may be the first sign of atrial fibrillation, infective endocarditis, hematological malignancy, or a hypercoagulable disorder.
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Management

Supportive Treatment

  • Analgesia

  • Adequate hydration

  • Antiemetics when required

  • Rest and clinical observation

Treat the Underlying Cause

  • Anticoagulation for thromboembolic or thrombotic causes when indicated

  • Antibiotics for infective endocarditis or splenic infection

  • Treatment of sickle cell crisis

  • Management of hematological or myeloproliferative disease

  • Treatment of the underlying malignancy or hypercoagulable state

Surgical or Interventional Treatment, Urgent surgical assessment is required for:

  • Splenic rupture

  • Hemodynamic instability

  • Splenic abscess

  • Persistent hemorrhage

  • Large symptomatic pseudocyst

  • Failure of conservative managemen

Complications

  • Splenic abscess
  • Splenic rupture
  • Hemorrhage
  • Splenic pseudocyst
  • Sepsis
  • Persistent abdominal pain
  • Loss of splenic function after extensive infarction

Prognosis

  • The prognosis is generally good in uncomplicated cases treated promptly.
  • Outcome depends mainly on the size of the infarction, the underlying disease, and the development of complications.
  • Splenic rupture, abscess, sepsis, and associated malignancy worsen the prognosis.

Key Points / Clinical Pearls

  • Splenic infarction results from interruption of the splenic blood supply.
  • Acute left upper-quadrant pain is the most common symptom.
  • Atrial fibrillation, infective endocarditis, and hematological disorders are important causes.
  • Contrast-enhanced CT is the preferred diagnostic investigation.
  • Treatment is mainly supportive and directed at the underlying cause.
  • Anticoagulation is used only when clinically indicated.
  • Splenic abscess and rupture are serious complications requiring urgent treatment.
  •  
  • Chapman J, Helm TA, Kahwaji CI. National Center for Biotechnology Information (NIH). Splenic Infarcts, StatPearls.
  • Wand O, Tayer-Shifman OE, Khoury S, et al. A Practical Approach to Infarction of the Spleen as a Rare Manifestation of Multiple Common Diseases. Ann Med. 2018;50:494-500. PMID: 29929401.
  • Yen CC, Wang CK, Chen SY, et al. Risk Assessment and Prognostic Analysis of Patients With Splenic Infarction in Emergency Department: A Multicenter Retrospective Study. Sci Rep. 2021;11:21423. PMID: 34728700.
  • MedlinePlus, National Library of Medicine (NIH). Splenic Sequestration Crisis: Medical Encyclopedia.
  • National Center for Biotechnology Information (NIH). Splenic Rupture, StatPearls.