Infarction of the spleen without obvious cause is an unusual clinical situation for which there is no standard diagnostic approach. We describe a patient whose workup revealed an important and treatable underlying cause.
A 71-year-old female smoker presented with a 2-week history of severe discomfort in the left upper quadrant radiating to the back that was associated with nausea and vomiting. Physical examination revealed mild diffuse abdominal tenderness; pelvic and rectal examinations were refused. The amylase and lactate dehydrogenase levels were slightly elevated. Findings of upper endoscopic and colonoscopic examinations were normal. Computed tomographic scans of the abdomen revealed a large splenic infarct. Laboratory evaluation for hypercoagulability was unrevealing. However, the cancer antigen 125 (CA-125) level was 3369 U/mL (normal, <35 U/mL), and the carcinoembryonic antigen level was 57.6 µg/L (normal, <5 µg/L). The patient then agreed to a pelvic examination, which demonstrated an absent uterus and a 9-cm left adnexal mass.
Hausdorff J, Bennetts J, Fuerstner R. Ovarian Carcinoma Presenting With a Splenic Infarct. Arch Intern Med. 1999;159(16):1954. doi: