CONCOMITANT RENAL AND SPLENIC INFARCTION

Introduction: Some organs, such as kidney and spleen, are supplied by end-arteries that irrigate welldefined parenchyma segments. When these arteries are occluded at any point, an infarct area with posterior fibrosis and loss of function may develop. Case Report: A 73 year-old female patient was referred for severe left flank and left upper quadrant abdominal pain for 48 hours associated with malaise and fatigue. Physical examination showed dehydration, heart rate of 100 beats/min with an irregular rhythm. Left upper abdominal palpation revealed pain. Laboratory analysis showed: lactic acid dehydrogenase = 2500 UI/ml, creatinine = 1.4 mg/ml, electrocardiography demonstrated typical atrial fibrillation, the abdominal CT scan showed no enhancement areas of spleen and left kidney. The patient was submitted to analgesia and systemic anticoagulation therapy. After 6 days the patient reported complete relief of symptomatology and was discharged. Discussion: The kidney and spleen, like the brain, are the most common organs that have infarctions caused by cardiac embolus. Coronary artery diseases and valvopathies are found in 30% of patients with renal infarction, while cardiac arrhythmia is found in 55%. The most frequent arrhythmia is atrial fibrillation. The incidence of renal infarction in an autopsy study was 1.4%, whereas the clinical diagnosis was made in only 0.014% of the studied patients. To our knowledge, there are only six reported cases of concomitant renal and splenic infarctions. This diagnosis should always be considered in patients with severe flank and left upper quadrant abdominal pain, with previous history of cardiac illness.