Migrating Needle in Right Ventricle Wall With Purulent Tamponade

BACKGROUND Migration of foreign bodies to the right ventricle is a very rare condition, but may lead to a life-threatening state in the patient. Moreover, the presentation of symptoms in such cases may be deceiving. CASE REPORT We report the case of a 41-year-old man with a long-standing history of intravenous drug abuse who was admitted with chest and epigastric pain accompanied by hematemesis. Computed tomography demonstrated a pericardial effusion and a thin metallic foreign body embedded in the right ventricular wall. Further history revealed needle breakage during intravenous injection 2 weeks prior to admission. Transthoracic echocardiography showed signs of cardiac tamponade. Due to elevated inflammatory markers, empiric antibiotic therapy was initiated, and the patient was referred for urgent cardiothoracic surgery. Surgical exploration revealed purulent pericardial tamponade and a 20-mm needle fragment embedded in the right ventricular wall, which was successfully removed. Microbiological cultures confirmed methicillin-sensitive Staphylococcus aureus infection. Postoperative recovery was uneventful, and inflammatory markers initially normalized under targeted antibiotic therapy. CONCLUSIONS The presented case illustrates a rare and unexpected complication of intravenous drug abuse. It highlights a rare dual-mechanism pathophysiology: purulent pericardial effusion occurring in the presence of an intramyocardial needle. To date, only a few similar cases have been reported in the literature. No specific symptoms allow for early diagnosis, and completing a proper anamnesis seems to be the most valuable action in such situations.