Splenic infarction, defined as ischemia of the spleen due to diminished vascular supply, is a clinical entity that may develop in various hematological, thrombotic, infectious, and neoplastic diseases. Upper left quadrant abdominal pain is the main symptom, but the clinical presentation can be delayed or even absent in the initial stages. A thorough clinical examination and imaging studies, such as ultrasonography and computed tomography, are key elements of the workup.
Necrosis and ischemia of splenic parenchyma occurring on the grounds of impaired arterial blood supply to this organ are termed splenic infarction and numerous conditions have been described as underlying causes . Infections (malaria, brucellosis, bacterial endocarditis, infectious mononucleosis, sepsis), hematologic disorders (sickle cell disease, thrombophilia, and most importantly, thromboembolic states), malignant tumors, and a range of miscellaneous conditions (antiphospholipid syndrome, pancreatic disease, and intrinsic splenic blood vessel malformations) are some of the most commonly reported etiologies     . The main presenting feature of a splenic infarction is abdominal pain, typically situated in the upper left quadrant    . As a result of irritation of the diaphragm, the pain can project to the left shoulder (known as Kehr's sign) and can be flank, whereas diffuse abdominal pain and pleuritic chest pain have also been reported    . Nausea, vomiting, fever, and chills are frequent accompanying complaints    . Furthermore, constitutional symptoms (fatigue, malaise) and a poor general condition might lead to a state of shock due to severe subcapsular bleeding that may be life-threatening  . In a significant number of cases, patients are often asymptomatic in the initial stages, especially those presenting with hematologic disorders as the underlying cause  .
The diagnosis of a splenic infarction can be made through a detailed clinical and imaging workup. Firstly, patients should be asked about the development of symptoms, their progression, as well as duration, since reports show that abdominal pain may last up to a week before the initial examination . Secondly, a detailed personal history encompassing preexisting neoplastic, prothrombotic, or hematologic disorders that could predispose the patient to ischemic events is also a vital component of the workup. The role of a properly conducted physical examination is even more important, as abdominal tenderness (particularly in the upper left quadrant), referred shoulder pain (Kehr's sign), and possibly splenomegaly can be detected  . Imaging studies, however, are pivotal when a presumptive diagnosis is made. Ultrasonography is one of the first methods that should be employed , and the presence of wedge-shaped lesions exhibiting a hypoechoic pattern is highly suggestive of an acute splenic infarction . Because ultrasonography does not pose a high rate of diagnosis (ranging from 18%-63% in isolated case series)  , computed tomography (CT) and magnetic resonance imaging (MRI) are superior studies that are recommended for the assessment of the spleen  . The use of contrast is favored for both studies (iodine for CT and gadolinium for MRI), and the previously mentioned wedge-shaped lesions are typically seen using both methods in the periphery of the organ (hypoechoic on CT and abnormal signal intensity on MRI, respectively)   . If the spleen is completely affected by ischemia, a diffuse hypodense appearance is observed .