Cardiac Tamponade Caused by a Needle in the Liver Presenting as a STEMI Mimic

We report a case of hemorrhagic pericardial effusion with tamponade, secondary to myocardial injury by a hypodermic needle lost during narcotics injection some months prior.

First presentation was with chest pain and global ST segment elevation following earlier cocaine usage. Urgent coronary angiography was performed to rule out acute coronary artery occlusion. A needle-like foreign body was seen abutting the right ventricle free wall, and the invasive pressure waveform suggested ventricular interdependence. Transthoracic echocardiogram revealed large-volume pericardial effusion which was drained immediately. The needle was ultimately removed during laparotomy and partial hepatectomy.

This case is unique and demonstrates how all available clinical information was collated to diagnose and treat life-threatening extra-coronary pathology with a rare etiology, in a patient whose history was unreliable.

The case highlights the importance of maintaining a broad differential diagnosis during emergency angiography in the presence of ST-segment elevation if no coronary occlusion is found.