Diagnostic Approach and Management of Splenic Infarction

Initial Assessment and Diagnostic Approach

Assess hemodynamic stability (systolic blood pressure ≥90 mmHg without signs of skin vasoconstriction, altered consciousness, or shortness of breath) in patients with suspected splenic infarction 1
Use contrast-enhanced CT scan as the gold standard for diagnosis of splenic infarction, as recommended by the World Journal of Emergency Surgery 2
Consider Doppler ultrasound (DUS) and contrast-enhanced ultrasound (CEUS) as useful adjuncts to evaluate splenic vascularization and for follow-up in patients with splenic infarction 1
Evaluate for collagen vascular diseases, pancreatic disorders, and splenic vascular abnormalities as potential causes of splenic infarction, although the strength of evidence for these associations is not specified 1

Admit patients with splenic infarction to an institution with 24/7 capacity to perform emergency interventions, as recommended by Anaesthesia 4
Provide continuous monitoring for at least the first 24 hours in an intensive care unit, as recommended by Anaesthesia 4
Implement clinical and laboratory observation for a minimum of 3-5 days, as recommended by Anaesthesia 4
Maintain bed rest for the first 48-72 hours in patients with uncomplicated splenic infarction, as recommended by Anaesthesia 4
Perform serial clinical examinations and laboratory monitoring in patients with splenic infarction, as recommended by the World Journal of Emergency Surgery 2
Consider repeat CT scan before hospital discharge and/or when complications are suspected in patients with splenic infarction, as recommended by Anaesthesia 4
Monitor for abdominal compartment syndrome, which can be a complication of splenic infarction, as recommended by Anaesthesia 4

Consider surgical intervention in patients with splenic infarction who develop complications such as splenic rupture or hemorrhage, as recommended by Praxis Medical Insights: Practical Summaries of Clinical Guidelines, although the strength of evidence for this recommendation is not specified 3