Presentation
Likely infective endocarditis. Now severe LUQ pain and palpable splenomegaly ?infarct.
Patient Data
Mild splenomegaly. In the mid-to-upper spleen is a hypoechoic, avascular band extending across the spleen measuring approximately 1cm in width, in keeping with a localized infarct.No free fluid.
Patient complained of increasing left upper quadrant pain and a CT was organized to asses for an progression of the splenic infarct or a new left kidney infarct.
Wedge-shaped hypodensities through the anteroinferior aspect of the spleen in keeping with splenic infarct. Small amount of perisplenic fat stranding. This has progressed compared to the recent ultrasound.
At the right renal midpole is a small cortical hypodensity. Cholelithiasis. Liver, adrenal glands and left kidney have a normal appearance. Small left pleural effusion and dependent left basal atelectasis.
Case Discussion
Splenic infarction in the setting of infective endocarditis is common, complicating approximately 35% (range 20-47%) of patients with left-sided infective endocarditis. Splenic infarcts themselves can be complicated by splenic abscess formation.
Unsurprisingly there is also a probable small renal infarct.