Splenic infarct

Case contributed by Dr Julian Maingard

Presentation

Patient with a known history of myelofibrosis presents with sudden sharp left upper quadrant abdominal pain.

Patient Data

Age: 70
Gender: Male
CT

This spleen is markedly enlarged and has a craniocaudal dimension of 28 cm. The liver has a craniocaudal dimension of approximately 26 cm. There are several areas of low attenuation present within the spleen, the largest of which is inferolateral and anteriorly located. It is approximately 4 cm in size on axial imaging. The spleen otherwise shows no definite abnormality. The pancreas and kidneys have a normal appearance. There aorta is of normal calibre. Some pelvic fluid is shown.

Case Discussion

The above case demonstrates hepatosplenomegaly and splenic infarction.

Myelofibrosis is a clonal stem cell disorder characterised by splenomegaly, chronic myeloproliferation, bone marrow infiltration, and extramedullary haematopoiesis (EMH) 1. It commonly presents with anaemia, palpable splenomegaly, and constitutional symptoms. Hepatosplenomegaly is a complication of significant EMH 2. Hepatomegaly and splenomegaly is seen in up to 40-70% and 90% of patients respectively 3.

Splenic infarction in myelofibrosis results from a combination of infiltration of the splenic parenchyma in EMH, anaemia and increased oxygen requirements of an enlarged spleen. 

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Case information

rID: 31486
Case created: 13th Oct 2014
Last edited: 18th Dec 2015
Inclusion in quiz mode: Included

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