Unusual presentation of a splenic infarction

TL;DR

A 41-year-old man with a splenic mass was found to have a hemorrhagic infarct, not a tumor, highlighting the challenges in diagnosing splenic lesions.

Contribution

This case highlights the diagnostic challenges and management decisions in splenic lesions with inconclusive imaging and pathology.

Findings

A splenic mass was initially suspected to be a neoplasm but was later diagnosed as a hemorrhagic infarct.

Splenectomy was preferred over biopsy due to risks of bleeding and tumor spread.

The case shows discrepancies between radiology and pathology assessments of splenic lesions.

Abstract

A 41-year-old male with a history of tobacco and alcohol use presented to our clinic for a follow up of an incidentally diagnosed splenic mass. The patient was sent for further diagnostic evaluation, and computed tomography showed a large splenic mass with heterogenous enhancement raising concern for neoplasm. Due to the uncertain nature of the splenic lesion and high complication rate of percutaneous splenic biopsy, a splenectomy was performed. The specimen was sent to pathology, and the report favored neoplasm but was inconclusive. The samples were sent to another institution for a consult, where the patient's spleen was determined to be the result of a previously suffered hemorrhagic infarct. This case demonstrates the difficulty of diagnosing splenic lesions using diagnostic imaging and the discrepancy that may occur between radiology and pathology assessments. In the setting of uncertain pathology, the removal of what might be a functional spleen is often preferred over a percutaneous biopsy due to concerns of intraabdominal bleeding and tumor dissemination.

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