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Needle Embolization: Suspecting Needle Migration in Intravenous Drug Abusers
Mor Levy1, Barry Hahn1, Ryan Aycock2
1Department of Emergency Medicine, Staten Island University Hospital, Northwell Health, Staten Island, New York.
The Journal of Emergency Medicine
|December 8, 2019
Summary
Central needle migration is a rare complication of intravenous drug abuse. Emergency physicians should suspect this condition in patients with a history of needle breakage and concerning symptoms like chest pain or fever.
Area of Science:
- Emergency Medicine
- Cardiology
- Radiology
Background:
- Intravenous drug abuse affects millions globally, with needle breakage a known risk.
- Central needle migration, though rare, is a serious complication of intravenous drug use.
- Cervical vein use in drug abusers increases risk for intravascular embolization.
Purpose of the Study:
- To highlight the rare but devastating complication of central needle migration in intravenous drug abusers.
- To emphasize the importance of considering needle embolization in emergency department patients with relevant history and symptoms.
- To review potential complications and diagnostic considerations for emergency physicians.
Main Methods:
- Case report of a 27-year-old male with a history of intravenous drug abuse presenting with neck pain after needle breakage.
- Computed tomography (CT) scan revealed a needle in the right ventricle with mediastinitis and jugular thrombus.
- Non-surgical management with broad-spectrum and oral antibiotics.
Main Results:
- A computed tomography scan confirmed a needle lodged in the right ventricle, causing mediastinitis and left internal jugular thrombus.
- The patient was successfully managed non-surgically and discharged on oral antibiotics.
- This case illustrates the potential for delayed diagnosis and serious complications.
Conclusions:
- Central needle migration is an underdiagnosed condition in intravenous drug users due to varied presentations.
- Emergency physicians must maintain a high index of suspicion for needle embolization in patients reporting needle breakage or presenting with unexplained symptoms.
- Prompt recognition and appropriate management are crucial to prevent severe sequelae such as cardiac perforation, thrombosis, and infection.
Keywords:
IV drug userIVDAabusercardiac perforationcentral needle migrationchest paincomplications of drug abuseconstrictive pericarditisdrugdrug abuserdrug userdyspneadysrhythmiaempyemafevergranulomaintracardiac needleintravenousneedle embolizationneedle fragmentationneedle migrationosteomyelitispneumothoraxseptic endocarditisshortness of breathvalvular damagevenous thrombosis
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