Conditions in this group
This group includes splenic infarction, splenic vein thrombosis, splenic artery aneurysm or pseudoaneurysm, and rare arteriovenous malformations.
How they develop
Splenic infarction occurs when the blood supply to part or all of the organ is interrupted, often because of embolism, hypercoagulability, a hematological condition, or infection. Splenic vein thrombosis may be associated with pancreatitis, pancreatic disease, portal hypertension, or thrombophilia. Splenic artery aneurysms may be diagnosed incidentally or become dangerous as they enlarge or rupture.
Symptoms, diagnosis, and treatment
Pain in the left upper abdomen, fever, or tenderness may occur with infarction. Splenic vein thrombosis may cause no symptoms or may present with complications of portal hypertension. Contrast-enhanced CT and, when indicated, angiographic examinations confirm the diagnosis.
Infarction is usually managed conservatively while the cause is investigated. Drainage or splenectomy is considered for complications such as abscess, rupture, or persistent uncontrolled pain. Splenic vein thrombosis is managed according to its cause and the overall vascular picture. A splenic artery aneurysm or pseudoaneurysm may require endovascular embolization or surgical repair.
Frequently asked questions
Is splenic infarction cancer?
No. It is a vascular problem affecting the blood supply, but the cause that produced it needs investigation.
Is anticoagulant treatment always needed?
The decision depends on the cause, extent of thrombosis, bleeding risk, and coexisting conditions.
When is an aneurysm treated?
The need for treatment depends on size, growth, symptoms, anatomy, and specific risk factors.
When to seek medical attention
Sudden severe pain in the upper left abdomen, especially with fever, nausea or pain at the tip of the left shoulder, needs same-day assessment because it can signal a splenic infarction. Call 112 for sudden severe pain with collapse, faintness or pallor, which can mean a ruptured splenic artery aneurysm, and for vomiting blood or passing black stools, which can be caused by swollen veins in the stomach after splenic vein thrombosis. A known aneurysm in a woman who is pregnant or planning pregnancy should be reviewed without delay.
What the assessment involves
Contrast CT, often as a CT angiogram, shows the spleen, its vessels, and any aneurysm, infarct or clot. Doppler ultrasound and MRI can help. The second part of the work-up is finding the cause: a heart rhythm recording and heart ultrasound to look for clot sources, blood tests for clotting disorders and blood diseases, and a pancreas scan, because pancreatitis or a pancreatic tumor can block the splenic vein. When splenic vein thrombosis is found, a gastroscopy checks for swollen veins in the stomach.
Treatment and recovery
Most infarcts settle with pain relief, fluids and treatment of the cause, over a few days to weeks. Blood thinners are prescribed for the period that suits the cause and bleeding risk, which varies from a few months to long term. A splenic artery aneurysm that needs treatment can often be blocked from inside the artery through a small catheter, with a short hospital stay, or repaired surgically. After embolization, pain, low-grade fever and tiredness for a few days are common and usually settle. Aneurysms that are not treated are followed with scans at intervals agreed with the surgeon. If the spleen is removed, the vaccination and fever advice in the splenectomy article applies.
More questions about splenic vessels
How common is a splenic artery aneurysm?
It is one of the more common aneurysms of abdominal arteries and is often found by chance on a scan done for another reason. Most never cause problems.
Why does pregnancy matter?
Aneurysm rupture is more dangerous during pregnancy for both mother and baby, so a known aneurysm is usually treated before a planned pregnancy.
Can a splenic infarct heal?
Yes. Small infarcts heal with a scar, and the rest of the spleen continues to work.
