splenic aplasia is seen when the spleen is congenitally absent , has been surgically removed , or becomes atrophic secondary to episodes of arterial / venous occlusion , which result in splenic infarction . this rare condition is caused by a heterogenous group of diseases , which may present a wide spectrum of clinical manifestations . splenic hypoplasia is defined as reduction in splenic mass and or functions caused by incomplete splenic development or secondary parenchymal involution . splenic infarction may be clinically silent and only discovered incidentally during abdominal exploration for other conditions . we present an unusual case of hypoplastic spleen with calcifications , which was preoperatively found during radiologic workup for gastric carcinoma . an 88-year - old woman presented with coffee - ground emesis . preoperative computed tomography scan showed a hypoplastic spleen with calcifications in the left upper quadrant . splenic hypoplasia is an unique entity , which may be seen in the setting of atrial fibrillation and abdominal malignancy . splenic function is compromised when the spleen is congenitally absent , has been surgically removed , or becomes atrophic from repeat episodes of arterial / venous occlusion causing a splenic infarction . splenic infarction occurs when the splenic artery or one of its major branches becomes occluded . in the modern era of percutaneous endovascular intervention , arterial embolization of the splenic artery has become the preferred treatment modality for many conditions such as traumatic splenic injury , massive variceal bleeding from splenic vein thrombosis , sinistral portal hypertension , or splenic sequestration . in a large autopsy series by okeefe et al . in 1986 , only 10% of the splenic infarctions were diagnosed antemortem . this condition is caused by a heterogenous group of diseases and can present a wide spectrum of clinical manifestations . splenic infarction which may leads to splenic hypoplasia could be spontaneous , clinically silent , or iatrogenic ( such as seen in the more widely accepted and performed splenic artery embolization during splenic hemorrhage ) . splenic hypoplasia may only be discovered incidentally during an abdominal exploration for other conditions . in other cases , we present an unusual case of incidentally found hypoplastic spleen during workup and treatment of gastric carcinoma . esophagogastroduodenoscopy demonstrated the presence of a gastric adenocarcinoma , for which open subtotal gastrectomy was planned . preoperative computed tomography ( ct ) showed an aplastic spleen with calcifications in the left upper quadrant [ figure 1 ] . coronal section of the abdominal computed tomography scan showing the hypoplastic and calcified spleen the hypoplastic spleen observed during laparotomy in a study of 49 patients with splenic infarction , antopolsky et al . reported that , predisposing factors to infarction were present in 71% of the patients . the most common predisposing factor was atrial fibrillation , which occurred in 23% of the reported cases . less common factors included antiphospholipid syndrome , previous history of thromboembolism , use of oral contraceptives , previous heart valve surgery , congenital or acquired hematologic disorders , nonhematologic cancer , and severe liver disease . while hereditary deficiency of protein c is one of the congenital causes of hypercoagulability resulting in splenic infarction , myeloproliferative disorders , lupus anticoagulant , polycythemia vera , and malignancy are more common . in clinical settings , splenic thromboembolism is associated with diverse cardiovascular conditions including atherosclerosis , acute myocardial infarction with left ventricular mural thrombus , atrial fibrillation , or bacterial endocarditis . reported a series of 10 patients with splenic infarction secondary to cancer , which included two patients with pancreatic adenocarcinoma and one patient with neuroendocrine tumor . the splenic infarction was incidentally diagnosed during routine ultrasonography ( us ) for tumor staging . in patients with pancreatic cancer , torsion of the splenic vessels , direct vessel invasion by the tumor , and extrinsic compression have been reported to cause a splenic infarction . when cancer is the underlying etiology , complete , instead of partial parenchymal infarction is more commonly seen . other less frequent symptoms include fever , pleuritic chest pain , back pain , left shoulder pain , and increased abdominal girth due to splenic congestion ( seen in pediatric populations ) . in 16.6% of patients , the diagnosis of splenic infarction was the first sign , which led to the diagnosis of underlying conditions , such as hypercoagulable state , atrial fibrillation , and polycythemia vera . a large number of experimental and clinical studies have contributed to current understanding of the physiology of the spleen and its role in the immunological defense against bacterial infection . overwhelming postplenectomy sepsis ( opsi ) has been the most feared potential complication after splenectomy . vilde reported 0.6% incidence of death caused by opsi in a series of 288 patients with splenic trauma . in another adult series by vichard and dreyfus - schmidt , 2.2% of patients experienced fatal opsi following trauma splenectomy . in cases of splenic aplasia or hypoplasia , however , symptoms of immunodeficiency are not always observed , such as in this case . computed tomography scan with intravenous contrast is currently the most effective noninvasive test available to diagnose splenic infarction . ct scan has the advantage of showing the infarcted spleen and other target organs , the extent of thrombosis , in addition to the potential underlying source of the problem . the most common finding is an area of decreased attenuation within the splenic parenchyma , which is not always wedge - shaped . us has lower sensitivity , but it may be used to differentiate hypogenic acute infarction from a hyperechoic healed lesion with or without calcifications . us can also be used to quickly evaluate the evolution of a splenic infarction into an abscess . ct scan and ultrasound have supplanted the use of traditional radionuclides studies for detection of splenic infarction . splenic infarction by itself is not an indication for a splenectomy unless persistent symptoms or complications such as splenic congestion , rupture , large cystic degeneration , or parenchymal abscess develop . have categorized indications for splenectomy into seven groups : splenic trauma , hematological diseases , malignancies , congestive and vascular diseases , symptomatic splenic cysts , iatrogenic rupture , and inflammatory diseases . in the current case , we hypothesize that the underlying atrial fibrillation and hypercoagulability related to gastric carcinoma may have caused the subclinical splenic infarction . cellular ischemia subsequently caused loss of membrane integrity , which is followed by calcium influx into the cell . the regenerative process as part of wound healing then continued with deposition of collagen by fibroblasts and other extracellular matrix components , causing the formation of fibrotic tissue . the end product of these processes was an involuted , fibrotic , and hypoplastic spleen with calcific changes . splenic hypoplasia is an interesting entity , which may be seen in the setting of atrial fibrillation and abdominal malignancy . splenic hypoplasia may be detected incidentally during radiologic workup or abdominal exploration , because abdominal symptoms or immunologic deficiency are not always present .
context : splenic aplasia is seen when the spleen is congenitally absent , has been surgically removed , or becomes atrophic secondary to episodes of arterial / venous occlusion , which result in splenic infarction 
 . this rare condition is caused by a heterogenous group of diseases , which may present a wide spectrum of clinical manifestations . 
 splenic hypoplasia is defined as reduction in splenic mass and or functions caused by incomplete splenic development or secondary parenchymal involution . 
 splenic infarction may be clinically silent and only discovered incidentally during abdominal exploration for other conditions.case report : we present an unusual case of hypoplastic spleen with calcifications , which was preoperatively found during radiologic workup for gastric carcinoma . 
 an 88-year - old woman presented with coffee - ground emesis . 
 her past medical history was only significant for atrial fibrillation . 
 esophagogastroduodenoscopy demonstrated gastric carcinoma , for which a subtotal gastrectomy was planned . 
 preoperative computed tomography scan showed a hypoplastic spleen with calcifications in the left upper quadrant . 
 symptoms of immunologic deficiency were not present . during laparotomy , 
 an atrophied and calcified spleen was identified and left in situ . 
 the patient made an uneventful postoperative recovery . 
 splenic hypoplasia is an unique entity , which may be seen in the setting of atrial fibrillation and abdominal malignancy.conclusion:splenic hypoplasia may be detected incidentally during radiologic workup or abdominal exploration . 
 abdominal symptoms or immunologic deficiency are not always present .