Tropical Medicine and Infectious Disease (Apr 2024)

Splenic Embolism in Infective Endocarditis: A Systematic Review of the Literature with an Emphasis on Radiological and Histopathological Diagnoses

  • Gabriel Santiago Moreira,
  • Nícolas de Albuquerque Pereira Feijóo,
  • Isabella Braga Tinoco-da-Silva,
  • Cyntia Mendes Aguiar,
  • Francijane Oliveira da Conceição,
  • Gustavo Campos Monteiro de Castro,
  • Mariana Giorgi Barroso de Carvalho,
  • Thatyane Veloso de Paula Amaral de Almeida,
  • Rafael Quaresma Garrido,
  • Cristiane da Cruz Lamas

DOI
https://doi.org/10.3390/tropicalmed9040083
Journal volume & issue
Vol. 9, no. 4
p. 83

Abstract

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Infective endocarditis (IE) is characterised by fever, heart murmurs, and emboli. Splenic emboli are frequent in left-sided IE. A systematic review of the literature published on splenic embolism (SE) between 2000 and 2023 was conducted. Search strategies in electronic databases identified 2751 studies published between 1 January 2000 and 4 October 2023, of which 29 were finally included. The results showed that the imaging tests predominantly used to detect embolisms were computed tomography (CT), magnetic resonance imaging, positron emission tomography (PET)/CT, single-photon emission computed tomography/CT, ultrasound, and contrast-enhanced ultrasound. More recent studies typically used 18F-FDG PET-CT. The proportion of SE ranged from 1.4% to 71.7%. Only seven studies performed systematic conventional CT screening for intra-abdominal emboli, and the weighted mean frequency of SE was 22% (range: 8–34.8%). 18F-FDG PET-CT was performed systematically in seven studies, and splenic uptake was found in a weighted mean of 4.5%. There was a lack of uniformity in the published literature regarding the frequency and management of splenic embolisation. CT scans were the most frequently used method, until recently, when 18F-FDG PET-CT scans began to predominate. More data are necessary regarding the frequency of SE, especially focusing on their impact on IE management and prognosis.

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