Splenic Infarct Due to a Patent Foramen Ovale and Paradoxical Emboli Post-COVID-19 Infection: A Case Study

Norton, Emma; Sheikh, Nadim

doi:10.7759/cureus.14887

Cited by 3 publications

(4 citation statements)

References 13 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Platelet function is also known to be affected by COVID-19 disease, i.e., abnormal platelet function may explain arterial thrombosis resulting from an increase in platelet activation at suboptimal thresholds and an increase in platelet aggregation in COVID-19 patients [ 20 , 25 ]. Despite these hypotheses, the exact mechanism underlying coronavirus-induced coagulopathy remains undetermined [ 16 , 28 , 29 ].…”

Section: Discussionmentioning

confidence: 99%

“…All these medical agents can be used for both prophylaxis and treatment depending on the patient's features and medical condition. However, failure of medical treatment in splenic artery occlusion is a strong indication for surgery, besides other scenarios such as hemorrhage, aneurysm, or a splenic abscess due to COVID-19 infection [ 28 , 32 , 33 ]. In our patient, we administered LMWH therapy in therapeutic doses for seven days until the patient's clinical deterioration forced us to proceed to laparotomy and splenectomy.…”

Section: Discussionmentioning

confidence: 99%

“…Routine use of LMWH should be followed in patients with SARS-CoV-2 infection, although some authors consider this controversial [ 11 , 27 , 31 , 38 , 39 ]. There is no consensus regarding the best therapy for arterial occlusion, and different authors have used a variety of medications for treating arterial infarcts after coronavirus infection [ 21 , 28 ]. However, it is crucial to determine the best therapy for acute arterial thrombosis in which not only the appropriate anticoagulant treatment regimen but also the correct dose is essential to improve prognosis, relieve symptoms, and significantly reduce mortality and disability [ 21 , 40 ].…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Splenic Artery Infarct Requiring Surgery: A Rare Complication of COVID-19 Infection

Dimitriou

Christodoulou

Chatzimargaritis

et al. 2022

Case Reports in Surgery

View full text Add to dashboard Cite

Introduction. Coronavirus disease (COVID-19) from SARS-CoV-2 infection is linked to a hypercoagulable state, leading to arterial and venous thrombotic events, of which pulmonary embolism is the most frequent. However, arterial thromboembolisms may also occur as visceral infracts in unusual sites, such as the renal, splenic, and intestinal arteries. Case Report. A 46-year-old unvaccinated male with a COVID-19 infection was admitted to the COVID-19 isolation ward with symptoms of respiratory infection. He complained of epigastric pain and fever for several days; radiological imaging of the abdomen revealed complete splenic arterial occlusion due to a large infarct. He was treated with low molecular weight heparin (enoxaparin) in therapeutic doses, resulting in minimal improvement. However, the pain worsened, and eventually, a laparotomy and splenectomy were performed. He was hospitalized for another 36 days before he was discharged in good condition. A second surgery was performed to remove a noninfected encapsulated hematoma from the subdiaphragmatic space. The patient remained healthy afterward, with no relapses. Discussion. Although rare, the number of cases of visceral infarcts in COVID-19 patients has increased. Splenic artery infarct is an exceptional case of acute abdominal pain that can be treated successfully with anticoagulant medication. Splenectomy may be required to manage refractory pain after failure of conservative management.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Splenic Artery Infarct Requiring Surgery: A Rare Complication of COVID-19 Infection

Dimitriou

Christodoulou

Chatzimargaritis

et al. 2022

Case Reports in Surgery

View full text Add to dashboard Cite

show abstract

“…Infection Cytomegalovirus [6][7][8] Epstein-Barr virus [9][10][11][12][13][14][15] Infective endocarditis [16][17][18][19][20][21][22] COVID-19 [23][24][25][26][27][28][29][30][31][32][33][34][35] Dengue virus [36] Mycoplasma pneumoniae [37,38] Malaria [39,40] Scrub typhus [41,42] Aspergillus pericarditis [43] Babesiosis [44] Malignancy including neoplasm and myeloproliferative diseases…”

Section: Causes Of Splenic Infarction Referencesmentioning

confidence: 99%

Clinical, Hematological, Biochemical and Radiological Characteristics for Patients With Splenic Infarction: Case Series With Literature Review

et al. 2023

View full text Add to dashboard Cite

Background Splenic infarction is a frequently missed diagnosis in acute clinical conditions and is often under-diagnosed due to the lack of high-quality evidence on pathophysiology of splenic infarction. Due to the scarcity of such evidence, no consensus guidelines regarding the diagnostic approach and management of patients with splenic infarction exist. Most of published articles on splenic infarction are case reports and there was no systematic review on splenic infarction. Methods We conducted a retrospective analysis of all radiologically confirmed cases of splenic infarction patients with any history of admission at National Center for Global Health and Medicine Kohnodai Hospital, from 2014 to 2020. Further, to understand the pathophysiology that causes splenic infarction, we searched the literatures on splenic infarction. Results We found 18 patients with splenic infarction. The average age was 78 years, and about half of patients had abdominal pain; however, the other half did not have abdominal pain. One-third of patients with splenic infarction died. Leukocytosis with neutrophilia, a decrease of lymphocytes, anemia, hypoalbuminemia, and liver dysfunction were observed. Fibrinogen was decreased and D-dimer was remarkably elevated. Lactate dehydrogenase (LDH) and C-reactive protein (CRP) were remarkably increased. Six patients (33.3%) had cancer, four patients (22.2%) had atrial fibrillation, and four patients (22.2%) had infection. We found 466 case reports on splenic infarction published from 1975 to 2021. Recently, the number of case reports on splenic infarction due to infection, especially, coronavirus disease 2019 (COVID-19), has been remarkably increasing. Furthermore, we found that leukocytosis, a decrease of lymphocytes, elongated activated partial thromboplastin time, decrease of fibrinogen, liver dysfunction, elevation of LDH and blood urea nitrogen can be the prognosis predicting factors for patients with splenic infarction. Conclusion Our study elucidated clinical, hematological, biochemical and radiological characteristics for patients with splenic infarction. We newly found significant differences in blood cell counts, coagulation markers, transaminases, LDH and blood urea nitrogen between patients who died and those who survived, suggesting that these parameters can be the prognosis predicting factors for splenic infarction. Further, our systematic review on case reports about splenic infarction showed the etiology of splenic infarction and the trend of the causative diseases.

show abstract

Clinical and morphological changes of the spleen in COVID-19 patients with and without splenectomy

Berestova,

Karagezyan,

Spaska

et al. 2024

ELECTRON J GEN MED

View full text Add to dashboard Cite

Patients diagnosed with COVID-19 were seen to develop splenic infarction or abscess. This study aims to estimate the incidence of splenic infarction/abscess in COVID-19 patients and to examine the clinical and morphological changes in the infected spleen. In the splenectomy group, 63.5% of patients had an enlarged spleen measuring between 12.1 cm × 5.1 cm and 19.2 cm × 12.2 cm. The incidence of splenic infarction was 36.4%, while the incidence of splenic infarction complicated by abscess was 18.1%. The size of splenic infarcts varied from 3.1 cm × 1.4 cm to 10.2 cm × 4.3 cm. Splenic abscesses were present in 72.3% of patients. Of 596 patients with severe COVID-19, 12 had at least one splenic abscess (2.3%): three patients had multiple splenic abscesses, while the rest had a single abscess pocket. Splenic infarction was found in 116 patients (22.5%), including 6 patients who later developed splenic abscesses.

show abstract

Splenic Infarct Due to a Patent Foramen Ovale and Paradoxical Emboli Post-COVID-19 Infection: A Case Study

Cited by 3 publications

References 13 publications

Splenic Artery Infarct Requiring Surgery: A Rare Complication of COVID-19 Infection

Splenic Artery Infarct Requiring Surgery: A Rare Complication of COVID-19 Infection

Clinical, Hematological, Biochemical and Radiological Characteristics for Patients With Splenic Infarction: Case Series With Literature Review

Clinical and morphological changes of the spleen in COVID-19 patients with and without splenectomy

Contact Info

Product

Resources

About