Surgical infective endocarditis and concurrent splenic abscess requiring splenectomy: a case series and review of the literature

Hasan, Leen Z.; Shrestha, Nabin K.; Dang, Vinh; Unai, Shinya; Pettersson, Gösta; El‐Hayek, Kevin; Coppa, Christopher P.; Gordon, Steven M.

doi:10.1016/j.diagmicrobio.2020.115082

Cited by 13 publications

(11 citation statements)

References 15 publications

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“…Classically, splenic abscess results from hematogenous seeding, preceding trauma, or other mechanisms [ 2 , 4 , 5 ]. Clinical factors associated with splenic abscess include splenic artery embolization [ 6 , 7 ], endocarditis [ 8 , 9 ], immunocompromised states [ 4 , 5 ], and, less commonly, pancreatic disease [ 10 , 11 ]. Microbiology is contingent upon the host and their respective global region.…”

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confidence: 99%

Splenic Abscess in the New Millennium: A Descriptive, Retrospective Case Series

Radcliffe

Tang

Gisriel

et al. 2022

Open Forum Infectious Diseases

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Introduction Splenic abscess is a rare infection often resulting from hematogenous spread. Immunocompromised states are commonly comorbid, and the microbiology is heterogeneous. Methods We conducted a retrospective review of 33 cases identified by convenience sampling. Cases were treated in our institution’s hospital system between May 2012 and February 2021 and classified as proven or probable based on predetermined criteria. Results The median age was 57 years, and 58% were men. Common underlying diseases included diabetes mellitus (30%), pancreatic disease (30%), and hematological malignancy (15%). The most common mechanism of pathogenesis was hematogenous spread (n = 13). Escherichia coli, enterococcal spp., and anaerobes were frequently implicated. One case was discovered at autopsy and excluded from subsequent analyses. The median duration of antimicrobial therapy was 45 days (range 5-525 days), and the median length of index hospitalization was 20 days. Percutaneous drainage by interventional radiology was common (17 of 32; 53%), and six patients underwent splenectomy. Treatment success was achieved in 14 of 32 cases (44%), with clinical stability in 3 of 32 cases (9%). Failures occurred in 41% (13 of 32) cases, two of whom died from splenic abscesses. Two patients (2 of 32) were lost to follow up. Conclusion To our knowledge, this is the largest North American series since the turn of the century and the first to distinguish between proven and probable cases. As reflected in our series, patients with splenic abscess may require prolonged hospitalizations and courses of antimicrobial therapy. Improvements in management are needed.

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confidence: 99%

Splenic Abscess in the New Millennium: A Descriptive, Retrospective Case Series

Radcliffe

Tang

Gisriel

et al. 2022

Open Forum Infectious Diseases

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“…Splenic infarcts (SI) occur as a result of embolization in 5.4% of patients with leftsided infective endocarditis; they can evolve to abscess formation in approximately 5% of patients [17][18][19]. In the present paper, we report a large P-MAIVF complicated with SI and abscess in a middle-aged Caucasian woman with negative blood cultures infective endocarditis affecting the bicuspid aortic valve.…”

Section: Introductionmentioning

confidence: 81%

Native Aortic Valve Endocarditis Complicated by Splenic Infarction and Giant Mitral-Aortic Intervalvular Fibrosa Pseudoaneurysm—A Case Report and Brief Review of the Literature

et al. 2021

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Background: Pseudoaneurysm of the mitral-aortic intervalvular fibrosa (P-MAIVF) is an unusual complication related to various injuries or conditions which involve the mitro-aortic region; it communicates with the left ventricular outflow tract and is associated with a high-risk of redoubtable complications or sudden death. The cerebral and splenic localizations are frequently seen as manifestations of systemic embolism in infective endocarditis. Currently, there are no specific recommendations related to the diagnosis, management, treatment, or further evolution of patients with P-MAIVF and concomitant splenic infarction. This paper presents the case of a 43-year-old Caucasian woman with a late diagnosis of mixed bicuspid aortic valve disease, affected by an under-detected and undertreated episode of infective endocarditis leading to asymptomatic P-MAIVF. Prime clinical and imagistic diagnosis of splenic infarction indicated further extended investigations were required to clarify the source of embolism. Methods: Integrated multimodality imaging techniques confirmed the unexpected diagnosis of P-MAIVF. Results: The case had a fatal outcome following an uncomplicated yet laborious cardiac surgery. Patient death was attributed to a malignant ventricular arrhythmia. Conclusion: The present case raises awareness by highlighting an unexplained and unexpected splenic infarction association with P-MAIVF as a result of infective endocarditis related to mixed bicuspid aortic valve disease.

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“…All studies were European, except for one conducted by our group in Brazil [25]. Conventional contrast-enhanced CT images may not differentiate between infarcts and abscesses except if done sequentially [9][10][11][14][15][16][17][18]. 18 F-FDG PET/CT was performed systematically in seven studies, and they found splenic uptake in 1.4-24%, with a weighted mean of 4.5%.…”

Section: Discussionmentioning

confidence: 99%

“…Fungal infections tend to generate multiple small lesions (up to 2 cm) that are poorly enhanced by contrast, similar to those caused by mycobacteria, which can lead to underdiagnosis. Monitoring the evolution of tomographic images can elucidate the difference between the two types of lesions; however, this may delay diagnosis and management and increase the risk of unfavourable outcomes [9][10][11][14][15][16][17][18]. MRI is a valuable tool for identifying intra-abdominal embolisms, with less toxicity and greater sensitivity than conventional CT; however, it has the disadvantage of causing discomfort to patients owing to the duration of the examination.…”

Section: Introductionmentioning

confidence: 99%

“…In non-contrast CT, the normal splenic parenchyma is described as having a homogeneous pattern with an intermediate attenuation coefficient of approximately 40–60 Hounsfield units (HU). One minute after contrast administration, heterogeneous contrast uptake may be observed in the arterial and initial portal phases, with subsequent homogenisation in the venous phase [ 9 , 10 , 11 , 14 , 15 , 16 , 17 , 18 ]. In contrast, splenic infarcts are triangular hypodense lesions of varying size with a base facing the periphery (wedge-shaped), with a predominantly peripheral location, and without contrast enhancement ( Figure 1 ).…”

Section: Introductionmentioning

confidence: 99%

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Splenic Embolism in Infective Endocarditis: A Systematic Review of the Literature with an Emphasis on Radiological and Histopathological Diagnoses

Moreira,

Feijóo,

Tinoco-da-Silva

et al. 2024

TropicalMed

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Infective endocarditis (IE) is characterised by fever, heart murmurs, and emboli. Splenic emboli are frequent in left-sided IE. A systematic review of the literature published on splenic embolism (SE) between 2000 and 2023 was conducted. Search strategies in electronic databases identified 2751 studies published between 1 January 2000 and 4 October 2023, of which 29 were finally included. The results showed that the imaging tests predominantly used to detect embolisms were computed tomography (CT), magnetic resonance imaging, positron emission tomography (PET)/CT, single-photon emission computed tomography/CT, ultrasound, and contrast-enhanced ultrasound. More recent studies typically used 18F-FDG PET-CT. The proportion of SE ranged from 1.4% to 71.7%. Only seven studies performed systematic conventional CT screening for intra-abdominal emboli, and the weighted mean frequency of SE was 22% (range: 8–34.8%). 18F-FDG PET-CT was performed systematically in seven studies, and splenic uptake was found in a weighted mean of 4.5%. There was a lack of uniformity in the published literature regarding the frequency and management of splenic embolisation. CT scans were the most frequently used method, until recently, when 18F-FDG PET-CT scans began to predominate. More data are necessary regarding the frequency of SE, especially focusing on their impact on IE management and prognosis.

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Surgical infective endocarditis and concurrent splenic abscess requiring splenectomy: a case series and review of the literature

Cited by 13 publications

References 15 publications

Splenic Abscess in the New Millennium: A Descriptive, Retrospective Case Series

Splenic Abscess in the New Millennium: A Descriptive, Retrospective Case Series

Native Aortic Valve Endocarditis Complicated by Splenic Infarction and Giant Mitral-Aortic Intervalvular Fibrosa Pseudoaneurysm—A Case Report and Brief Review of the Literature

Splenic Embolism in Infective Endocarditis: A Systematic Review of the Literature with an Emphasis on Radiological and Histopathological Diagnoses

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