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Splenic arterial dissection and factor V Leiden mutation causing massive spleen infarction.

A 48 year-old man was referred to emergency ward because of pain on the left side of the abdomen and low-grade fever, triggered by moderate physical exercise. He smoked 20 cig./day but denied hypertension, diabetes or dislipidemia. Physical examination was unremarkable. Serum biochemistry showed total cholesterol 255 mg/dL, LDL cholesterol 167 mg/dL, HDL cholesterol 35 mg/dL and triglycerides 250 mg/dL. EKG, heart and abdominal ultrasound were normal. An abdominal scan showed a spleen infarction affecting 60% of the gland. A CT angiogram and a selective celiac trunk angiogram showed a reduction of the lumen of the splenic artery, suggesting dissection and mild atherosclerosis (Fig. 1). Test for prothrombotic states confirmed the G1691A factor V Leiden mutation. After being admitted to the hospital, enoxaparin was administered and the spleen was surgically removed. Pathological examination confimed both splenic infarction and arterial dissection (Fig. 2). Patient was discharged with warfarin and atorvastatin.