Acute splenic infarction
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* Samaad Malik
* Patrick Duffy
* Paul A. Shulte

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![Figure1](http://www.cmaj.ca/https://www.cmaj.ca/content/cmaj/175/3/244.1/F1.medium.gif)

[Figure1](http://www.cmaj.ca/content/175/3/244.1/F1)

Figure. A 41-year-old East Indian man arrived at hospital complaining of acute pain in his lower-left abdominal quadrant; an examination revealed some tenderness in that area, low-grade fever, leukocytosis and neutrophilia. An abdominal CT scan with contrast was ordered. What's your diagnosis?

Although no intense pelvic symptoms were found during the physical exam, the CT scan showed a wedge-like hypodense area in the spleen (Fig. 1, arrow) consistent with acute splenic infarction. Results of a hypercoagulable work-up were normal. Electrophoresis revealed hemoglobin S at 40%, consistent with heterozygous sickle cell trait. The patient was treated conservatively with analgesia and fluid rehydration; his symptoms resolved.



![Figure2](http://www.cmaj.ca/https://www.cmaj.ca/content/cmaj/175/3/244.1/F2.medium.gif)

[Figure2](http://www.cmaj.ca/content/175/3/244.1/F2)

Figure. 

Sickle cell disorders are the commonest genetic hematological disorders; the gene is frequent among people of African-American and Asian extraction. When heterozygous, the condition is called sickle cell trait; even so, it is usually asymptomatic. Nevertheless, people with homozygous sickle cell disorder as well as the heterozygous trait have been known to undergo tissue infarction. Although splenic infarction is rare, it is a recognized and dramatic complication of sickle cell trait (*Am J Med* 1989;87:30-4).

Splenic infarction usually causes pain in the left upper quadrant of the abdomen, although the pain is occasionally referred to the shoulder. Comorbid conditions (e.g., thalassemia, hypoxia, infection) and exposure to high altitudes (those above 3000 m or 10 000 feet) can precipitate infarction. In people with sickle cell trait, this can include microvascular infarction of the renal medulla.

Complications of splenic infarction include abscess or pseudocyst formation, rupture and hemorrhage.

Patients with sickle cell trait and splenic infarction have been documented to have leukocytosis and fever in the first 72 hours. Patients who are having a sickle cell crisis may have an associated marrow response (leukocytosis, reticulocytosis). Our patient was unusual in that he had no evidence of active infection or bacteremia, nor had he been exercising or at a high altitude.