I was diagnosed with a non traumatic splenic infarction in

Patient

Q: I was diagnosed with a non traumatic splenic infarction in an ER and told to follow up with a hematologist/ oncologist as soon as possible. First appointment I could get was in 1 week. The pain is severe in my left abdomen and shoulder and I have micro cystic anemia, Shortness of breath and heart rate of 110. I have been running a low grade fever of 100.5 for a few days. No signs of internal bleeding in the CT scan. I am I ok to wait for 5 days to see the doctor, or at what point do I need to seek emergency care before then?

Doctor

A:   Welcome to Ask The Doctor.
We are here to help you on this medical health advice platform.
Splenic infarction that is non-traumatic is serious issue. Since you know there are many causes behind it and most common being Malginancies like Lymphoma or Leukemia, this becomes am emergency , if you start having chest pain and breathlessness as the infarction might have occurred in pulmonary vasculature leading to breathlessness.
I suppose, you should go to ER. They will examine you and will perform a CT Chest and ECHO to rule out Pulmonary infarction.
ECHO is required as emboli can also travel to heart valves causes infective endocarditis and that can cause fever. So, a definitive workup is required. You can't wait for an appointment with an oncologist as he would be assessing you for Leukemia and Lymphoma only.
This is very common to have Pulmonary infarction and infective endocarditis in a person who has splenic infarction, whatever the cause might be behind that.
See, evaluation of cause is important here but at present you need evaluation for cause of this fever, breathlessness. If any infective endocarditis is found, you would require blood cultures and antibiotics for that.
So, this is the point where you should go to ER as probably you have got further complications due to the underlying disease.
Go to ER, Share my opinion and let them evaluate.
If you have any further query, feel comfortable to ask me.
I hope it helps.
Stay Healthy.

Comments / Follow Ups

Patient: Thank you. It was an independent ER that did the CT with contrast that found the splenic infarction. The first CT scan without contrast showed nothing but a possible air bubble in my abdomen. I am five years post op from Gastric Bypass Roux n Y procedure and they though I might has blown staple. After I insisted there was something wrong, they did the second CT scan and saw the spot on my spleen indicating no blood flow. The area is about an inch long (At least I think that is what he said.) Admittedly the doctor did not know much about it, and was at first going to have me transferred to the hospital as he thought it might be a surgical issue, but he spoke to a general surgeon who said that it was not an urgent surgical issue and to send me home and tell me to set a follow up with a hematologist/oncologist. They gave me a prescription for Tylenol with codeine and a referral. Clearly, not comfortable with that as a final plan of action as I am still in a significant amount of pain, but afraid of looking like a hypochondriac. The only other doctor I see on a regular basis is a urologist for kidney stones, so I don't know if I should get in to see a GP, or go back to the ER requesting more tests as you suggest. It just would be my this ER visit on a week, although there was nothing discovered in the first visit that indicated a problem with the spleen. They only saw a small amount of pleural effusion on my left side and said that could be causing the pain. They also said at both places that they only consider a temperature of 101+ a fever that is clinically significant and my white blood cell count is in the normal range, and actually went down between the blood work run on Saturday the blood work done on Sunday. The RBC count went down as well and is indicated in the low range. My Hemoglobin is 7.2 and hematocrit, MCV, MCH, MCHC were all low and my RDW was high. They also mentioned I had leukocytes in my blood
Doctor: I suppose, Infective endocarditis needs to be considered. Discuss my opinion with your doctor.. He will surely post you for ECHO.
Good Luck.

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