Acute LUQ pain with embolic source, suspected splenic infarction
Recommended: CT Abdomen with IV contrast is the preferred imaging study for acute luq pain with embolic source, suspected splenic infarction. Wedge-shaped peripheral low attenuation.
Recommended study
CT Abdomen with IV contrast
Wedge-shaped peripheral low attenuation. Etiologies: A-fib, endocarditis, sickle cell, pancreatitis (splenic vein thrombosis), hypercoagulable.
If the default doesn't apply
Contrast contraindicated
MRI
MRI Abdomen with DWI
No contrast
Watch-outs
Atrial fibrillation source
TTE + LAA imaging (TEE) for source; anticoagulation per AF guidelines.
Multiple visceral infarcts
Consider broad embolic / hypercoagulable source — image kidneys / brain accordingly.
Pearls
- Wedge-shaped peripheral low attenuation pointing to splenic hilum.
- May progress to abscess (superinfection) or splenic rupture (large infarct).
- Sickle cell autosplenectomy: progressive infarction → calcified small spleen.