Other lesions of the spleen
- Lesion
The spleen can lose its blood supply, tear, carry rare tumours or extra small spleens, and when it is gone serious infections follow.
What it is
Splenic infarcts are common because the spleen has end arteries; in a normal-sized spleen they are usually embolic from the heart, while in a massive spleen they arise because the blood supply cannot keep up. Rupture usually follows blunt trauma; spontaneous rupture happens only in spleens made fragile by rapid enlargement. Primary tumours are rare, mostly haemangiomas and lymphangiomas, while lymphoid and myeloid neoplasms often involve it secondarily. Accessory spleens are common; absent or nonfunctioning spleens leave patients vulnerable to encapsulated bacteria.
Structure
- Recent infarct: haemorrhagic wedge with fibrinous exudate on the overlying capsule; old infarct: pale yellow-grey depressed scar.
- Rupture: capsular tear with intraperitoneal haemorrhage.
- Haemangioma: spongy red blood-filled spaces; lymphangioma: thin-walled spaces with clear fluid.
Step by step
- An embolus (from left heart thrombus or valve vegetation) occludes a splenic artery branch.
- The wedge of tissue supplied by that end artery undergoes coagulative necrosis.
- Inflammation, then fibrosis, turns the infarct into a depressed scar.
- Repeated infarcts (sickle cell disease) shrink the spleen to a fibrotic nubbin.
- Loss of filtering and of marginal-zone B-cell antibody responses leaves encapsulated bacteria unchecked.
Clinical notes
- Left upper quadrant pain and shoulder-tip pain (Kehr sign) suggest rupture or a large infarct.
- Patients with infectious mononucleosis are told to avoid contact sports while the spleen is enlarged.
- Asplenic patients need vaccination against encapsulated bacteria.
Test yourself
Think of the answer, then tap the question to see it.
What does a bland splenic infarct look like grossly?
A pale, wedge-shaped, subcapsular area with its base on the capsule, later becoming a depressed scar.
Which conditions predispose to spontaneous splenic rupture?
Infectious mononucleosis, malaria, typhoid fever and lymphoid neoplasms, which enlarge the spleen rapidly.
Why does an overlooked accessory spleen matter?
After splenectomy for a disease such as hereditary spherocytosis, it can enlarge and take over the function, so the treatment fails.
Elsewhere in DurgiPedia
- Mesenteries, the omental bursa and the spleen
- Spleen: white pulp, red pulp, asplenia
- Secondary immunodeficiency: HIV, malnutrition, drugs, asplenia
Connections
Microorganisms2
Educational content on the mechanisms of disease; not a diagnostic or treatment guide and no substitute for a health professional's advice. No doses are given.
Sources: Splenic Trauma (StatPearls (NCBI Bookshelf), 2026); Spleen Diseases | MedlinePlus (MedlinePlus, US National Library of Medicine, 2026).
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Representative model, for educational purposes only.