Clinical diagnosis
Case 186
【Progress】
She was administered heparin and warfarin which gradually induced pain relief. One month later, CT showed almost disappearance of low density in the spleen, indicative of absorption of infarcted area.
【Discussion】
Splenic infarction is not so often encountered in the clinical reality. Splenic ischemia occurs in cases of arterial occlusion, peripheral embolism and venous occlusion (1-4). However, both changes of splenic artery stenosis or occlusion and splenic vein occlusion which met in case of pancreas body or tail cancer do not always bring out splenic infarction probably because occlusive speed of tumor is too slow to create splenic infarction (2). The collateral pathway from subphrenic artery and/or gastroepiploic artery can irrigate splenic blood flow in case of gradual arterial occlusion. Further, in case of gradual splenic vein occlusion, gastroepiploic vein and/or gastro-splenic shunt can develop. Then, the relatively speedy occlusive mechanism is necessary to create splenic infarction irrespective of arterial occlusion or splenic vein occlusion (5).
Cardiac atrial fibrillation or bacterial endocarditis causes splenic infarction or abscess, respectively (1-5). Acute or relatively acute splenic vein thrombosis also can cause splenic infarction. Splenic infarction due to splenic vein thrombosis occurs in case of pancreatitis, sickle cell disease, paroxysmal nocturnal hematuria, oral contraceptive pills (5-8). The adverse effect after splenic vein thrombosis is forming gastric varices which can cause rupture, inducing hematemesis and sometimes lethal.
In our case, she was fifties and had oral contraceptive pills for not avoiding pregnancy but for decreasing massive menstruation which was a source of her anxiety. Further, she smoked 10 cigarettes/day and had dehydration which induce facilitate coagulopathy. She was administered heparin and warfarin. One month later, splenic infarction decreased remarkably on follow up CT.
【Summary】
We present a fifty one-year-old female for left hypochondriac pain persistent for two weeks. She also experienced mild fever while feeling the pain. Enhanced abdomen CT using contrast medium showed large low density occupying in the spleen and splenic vein thrombus, diagnosing splenic infarction duet to splenic vein thrombus. She had oral contraceptive pills for decreasing menstruation, smoked cigarettes and dehydration, inducing splenic vein thrombus and splenic infarction. It is borne in mind that splenic infarction is caused by relatively speedy occlusion of splenic artery or splenic vein. Splenic arterial ischemia arises from cardiac atrial fibrillation or endocardial bacterial embolism. Splenic venous ischemia arises from pancreatitis, sickle cell disease, paroxysmal nocturnal hematuria, oral contraceptive pills.
【References】
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2020.4.1