Needle Pulmonary Embolism in an Intravenous Drug User: a Case Report
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Needle Pulmonary Embolism in an Intravenous Drug User: a Case Report Amr A. Arafat 1 & Mustafa Rady 1 & Mohamed Ebrahim 1 & Ahmed F. Elmahrouk 1 Accepted: 21 October 2020/ # Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract
Pulmonary needle embolization in intravenous drug users is rarely reported in the literature. The management of these patients is controversial. We presented a male patient aged 33 years old who presented with a broken needle in the left arm after a trial of selfdrug injection. During the trial to retrieve the needle, it embolized to the lung. Chest Xray and CT scan showed the needle in the right lower lobe. We managed the patient conservatively; then, the patient was discharged on antiplatelet therapy. After the 6-month follow-up, the patient was asymptomatic with no complication. Keywords Pulmonary embolism . Intravenous drug users . Foreign body embolism Central needle embolization in intravenous drug users is rare, with few cases reported in the literature (Monroe et al. 2015). It is not known whether an embolized needle has a predilection to a specific side or lobe. There is no consensus on how to manage these patients since the reported complications are very rare. The embolized needle may pass unnoticed because of the stigmata of abusing drugs in our community, yet it may present later with pulmonary complications. Increasing the awareness of this rare entity could help detect more cases with more accurate monitoring of the long-term consequences. Several reports of foreign body
* Ahmed F. Elmahrouk Ael–[email protected]; [email protected] Amr A. Arafat [email protected] Mustafa Rady [email protected] Mohamed Ebrahim [email protected]
1
Cardiothoracic Surgery Department, Tanta University, Tanta, Egypt
International Journal of Mental Health and Addiction
pulmonary embolism are present in the literature (Rief et al. 2013; Naito et al. 2014; Bakir et al. 2020); however, needle embolization is scarce.
Case Report A 33-year-old male presented to our hospital with a broken needle in his left arm after a trial of self-drug injection. His first complaint was shoulder pain on the left side, where the vascular surgeons detected the needle on a shoulder X-ray. We performed laboratory investigations to detect blood-borne infections, and the patient was hepatitis C virus-positive. Under fluoroscopic guidance, the vascular surgeons performed a trial to remove the needle surgically (Fig. 1); however, the needle migrated. A chest X-ray showed the needle in the right lung (Fig. 2). A chest contrast-enhanced CT scan was done and revealed the needle embedded in the right lower lung lobe (Fig. 3). There was no evidence of pulmonary venous thromboembolism or infarction and no detectable pericardial effusion. The decision was made to manage the case conservatively. The patient complained about chest pain localized to the right side, controlled with nonsteroidal anti-inflammatory (NSAIDS) analgesics. The patient was discharged on
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