Epicrisis: A 19-year-old female patient with a severe congenital heart defect reports sudden severe pain in her left flank 14 days ago. Ultrasound shows the spleen to be correctly located, with extensive infarction of the lower half of the spleen. Neither color Doppler nor CEUS revealed perfusion in the lower half of the spleen. Anticoagulation was initiated and a follow-up examination was scheduled in 4 weeks.