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February 1985

Surgical Management of Splenic Abscess in Endocarditis-Reply

Arch Intern Med. 1985;145(2):370-371. doi:10.1001/archinte.1985.00360020214050

—We studied the necrosis of 78 active cases of infectious endocarditis (IE) between 1968 and 1979. Five splenic abscesses were found (6%), an incidence of 0.5% per year.1

In our clinical series of 120 patients with IE between 1974 and 1982, the spleen was clinically important in only five cases: one spleen rupture, one suspect spleen with persistent fever (spleen culture negative), one splenic abscess discovered at necropsy, another seen on computed tomographic (CT) scan, and a case of multiple septic infarcts. This yields 0.8% prevalence and an incidence of 0.07% per year.

Thus, the frequency of such abscesses in IE seems to be low, but that of the infarcts seems to be underestimated. The differentiation between infarct and abscess is difficult with the current imaging methods. Moreover, infarcts frequently become abscesses (32% in our necropsy series). The precise diagnosis relies then on a careful clinical and biological follow-up.