Background: We summarize our experiences with splenic lesions in the setting of infective endocarditis (IE) and review the current issues related to their diagnosis and management. Data Sources: A literature search using the terms "splenic infarct" and "splenic abscess" was conducted using PubMed (National Library of Medicine). We primarily selected manuscripts published in English and gave particular attention to those from 1980 to 2004 relating splenic infarct or abscess to IE. Conclusions: Although new onset left upper quadrant abdominal pain or tenderness and persisting fever and bacteremia suggest splenic infarction or abscess, a high percentage of patients with splenic lesions lack these findings making accurate prediction difficult and general recommendations for abdominal computed tomography in the setting of IE controversial. Likewise, reliably distinguishing splenic infarct from abscess using ultrasonography, radiological or radionuclide procedures frequently is not possible. Recent experience in using computed tomography-guided percutaneous aspiration for diagnosis and treatment of splenic abscess is somewhat encouraging. However, this procedure has not replaced splenectomy as standard of care in managing splenic abscesses.
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