Imaging findings of massive splenic infarction that occurred before liver transplantation: a case report

초록

Introduction: Splenic infarction, often linked to hemato-oncological, infectious, immunological conditions, or ischemia, occurs when the spleen's arterial or venous circulation is compromised. We present the case of a 56-year-old male with alcoholic liver cirrhosis who developed massive intraabdominal bleeding and hepatorenal syndrome preoperatively, and successfully underwent liver transplantation (LT). Case Description: The patient was transferred to our tertiary institution due to worsening refractory ascites and recently developed intraabdominal bleeding. A CT scan confirmed hemoperitoneum, and successful embolization was performed on the bleeding cystic artery branch. Retrospective CT review showed a large, indistinct low-density area in the spleen, but this was initially missed. However, no physician, including the radiologist, was aware of the spleen issue at that time. Subsequently, living donor LT was performed using a modified right lobe graft of the orthotopic standard type, and splenic artery ligation was not performed. On postoperative day 3, a CT follow-up revealed a massive splenic infarction was recognized for the first time on imaging. Subsequently, complicated fluid collection that could not be controlled with conservative treatment continued in the perisplenic area. Therefore, an exploratory laparotomy, including splenectomy, was performed 48 days after the LT. Histopathology showed the spleen was hemorrhagic and necrotic appearance with cystic change, consistent with splenic infarction. Discussion: We hypothesize that the massive splenic infarction most likely resulted from hypoperfusion and a hypercoagulable state before liver transplantation, and authors believe it had a negative impact on the patient's recovery after the liver transplantation.