Spleen Size and Appearance by Transesophageal Echocardiography in Patients With Suspected Infective Endocarditis

Background:

The diagnosis of Infective endocarditis (IE) relies on a combination of clinical, laboratory and imaging findings. TEE is the mainstay of IE diagnosis. The spleen is commonly involved in IE as a target for septic emboli, which is a minor diagnostic criterion. During a TEE study, the spleen can be easily imaged from the trans-gastric view. We report our experience with imaging the spleen by TEE in patients with suspected IE, as compared with standard abdominal imaging.

Methods:

We retrospectively analyzed TEE cases performed due to suspected IE, which reported spleen size or appearance. Spleen size by TEE was measured at the long- and short-axis, while its texture and focal findings were evaluated visually. All of these findings were compared to recent standard abdominal imaging of the index patient.

Results:

Forty patients (73% male, mean age 50±18) had a description of the spleen in their TEE report, of which 30 (75%) had additional abdominal imaging, primarily computed tomography (CT). Sixteen patients (40%) had evidence of splenomegaly by abdominal imaging. There was significant overlap in spleen size as measured by TEE between those with vs. without splenomegaly detected by standard abdominal imaging. Four patients (10%) with IE had focal splenic findings in standard abdominal imaging, which were all visualized by TEE.

Conclusion:

This is the first study to report the use of TEE to evaluate the spleen, as well as to evaluate the spleen in patients with suspected IE. TEE is a simple, non-cost adjunctive method to evaluate spleen size and detect focal lesions. Potentially, the presence of splenic abnormalities could be utilized to support the diagnosis of IE.