Needle embolus causing cardiac puncture and chronic constrictive pericarditis

Depressed mother penetrating her Baby's heart with a sewing needle during COVID-19 lockdown: A case report

Background

The full lockdown was carried out in China as well as in other countries during the COVID-19 pandemic, and it proved to be effective in reducing the rate of transmission in the early stage of the pandemic. However, the negative effects of full lockdown on human mental health should be taken into consideration.

Case presentation

During COVID-19 lockdown, a 3-month-old male infant was injured with a sewing needle penetrating into his heart by his mother with postpartum depression. The mother had a history of depression, and she reported depressive feelings during quarantine before injuring the infant. In addition, her own mother's health condition had worsened lately following long-term stroke sequelae. These factors may have contributed to her new depressive episode, which caused her to injure her baby with a threaded sewing needle with no witness. The injury was discovered the next day by the infant's paternal grandmother. The baby received an emergency sewing needle removal operation and recovered uneventfully.

Conclusions

Special attention should be paid to persons with a high risk of mental disorder during this pandemic, in order to avoid devastating adverse events or deterioration of conditions for them and those around them.

Unusual Needle Migration into the Heart of a Pediatric Patient

Sharp-object penetration into the chest is rare and may lead to life-threatening complications, hence the significance of early detection and removal. We present an uncommon case of the accidental penetration of a sewing needle into the chest of a 5-year-old girl, with the needle traveling from the entrance site to the right ventricle through the lung tissue. Due to the possibility of cardiovascular accidents, the patient was transferred to a special ward. For positioning and correct actions, TTE and CT scan of the chest with and without contrast were performed and the presence of a tangential needle with the right ventricular wall and inside the pericardium was reported. The patient was taken to the operating room, and after exploring, a 2 cm needle was inserted into the right ventricle and removed. The patient was discharged after 5 days.

Needle Embolism to the Heart: A Case Report and Review

Needle embolisms in the heart are quite rare, and their management is largely based on clinical experience. We describe a patient with chest pain and shortness of breath, whose electrocardiogram revealed subtle inferolateral ST segment elevations. The patient was found to have a bloody pericardial effusion causing tamponade from a long-ago injected needle. Removal of a needle is a complicated decision, that should be done in a multi-disciplinary fashion to minimize complications. Removal may not always be necessary if the needle is in a stable position and not in danger of migration.

Migration of a Varicocele Coil to the Right Heart

We describe a case of an adult patient with embolization of a varicocele coil (7 × 70 mm) to the right ventricle. We review the multimodality imaging techniques used to identify location and the importance of a multidisciplinary approach in determining management. (Level of Difficulty: Advanced.).

A case of needle embolism in a drug abuser, a diagnostic and therapeutic challenge

Background

Needle embolism is a rare complication of intravenous habit. Clinical manifestations include recurrent pericarditis, tamponade, cardiac perforation, and infective endocarditis. We describe the case of needle embolization in a young intravenous opiate abuser.

Case presentation

We describe a rare complication of intravenous misuse in a 23-year-old patient. He presented at the emergency department with chest pain and shortness of breath. He complained of remittent fever ensued 6 months before. Echocardiographic and radiologic images revealed pericardial effusion and a needle fragment inside the pericardium. The needle was removed through left-anterior mini-thoracotomy, after CT-guided carbon tracking.

Conclusions

The presence of a foreign body within the heart resulted from the migration of a needle fragment from a peripheral vessel. It caused fever and recurrent pericarditis. In similar cases, surgical extraction is the therapy of choice.

Intracardiac foreign body: A rare cause of recurrent fungemia

BACKGROUND

An intracardiac foreign body causing recurrent fungemia is a rare clinical situation. Clinicians should be that aware of rare sources of sepsis despite a thorough history and examination.

RESULTS

The authors describe a 63 year-old man, with unremarkable past medical history, who presented with a fever for 2 weeks. Blood cultures persistently grew Candida albicans and Streptococcus constellatus. Echocardiogram assessment showed a suspected vegetation over the tricuspid valve. Surgical exploration with median sternotomy and cardiopulmonary bypass revealed a tooth-pick impacted within the right atrium surrounded by vegetation. The authors postulate accidental ingestion of the foreign body and translocation into the right atrium via the esophagus and thoracic cavity.

CONCLUSION

Surgical removal of symptomatic intracardiac foreign bodies is highly recommended.

Needle Embolization: Suspecting Needle Migration in Intravenous Drug Abusers

BACKGROUND

Thirteen million people inject drugs globally, making intravenous drug abuse a substantial concern worldwide. While intravenous drug users occasionally report the breaking of a needle into the skin or subcutaneous tissue, central needle migration remains a rare but potentially devastating complication.

CASE REPORT

A 27-year-old man with a history of intravenous drug abuse presented to the emergency department with the sudden onset of left-sided neck pain, chills, and subjective fever with a history of needle breaking in his left neck 3 weeks earlier while using heroin. A computed tomography scan of his chest revealed a needle lodged in the right ventricle with associated mediastinitis and mass effect on the left brachiocephalic vein, and a left internal jugular thrombus. Broad-spectrum antibiotics were initiated. This patient was managed nonsurgically for several reasons and was discharged on hospital day 12 with oral antibiotics. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Intravenous drug abusers commonly use cervical veins when their peripheral vasculature has become sclerosed. This puts intravenous drug users at increased risk for intravascular embolization. Due to varied symptomology-chest pain, dyspnea, fever, or asymptomatic-and timelines-days, weeks, or months-after reported needle fragmentation, this remains a complex and likely underdiagnosed condition. Case reports describe serious complications of intracardiac needle embolization, such as cardiac perforation, constrictive pericarditis, septic endocarditis, dysrhythmias, granulomas, venous thrombosis, empyema, acute or delayed spontaneous pneumothorax, osteomyelitis, and valvular damage. In this complicated patient population, clinicians should consider needle retention and relocation in patients who report needle breaking or in those who present with chest pain, dyspnea, or fever among other complaints.

Embolic Hypodermic Needle Causing Traumatic Cardiac Tamponade: A Case Report

We present a unique case of a broken fragment of a hypodermic needle breaking and embolizing to the heart. This needle subsequently penetrated the right ventricle and the patient developed hemopericardium which resulted in cardiac tamponade physiology.

DATA SOURCES

None.

STUDY SELECTION

None.

DATA EXTRACTION

None.

DATA SYNTHESIS

Recognizing the potential for unusual and serious complications of IV illicit drug use is an important part of providing effective and timely medical care in this vulnerable population.

CONCLUSIONS

An embolic needle phenomenon can have significant sequela, including direct cardiac trauma leading to tamponade and subsequent cardiac collapse. Partnering with the patient to take a detailed history was critical in uncovering the underlying etiology of this patient's cardiogenic shock.

Tricuspid Valve Incompetency Due to the Grenade Chip Embolization to the Heart

Migration of foreign bodies into the heart, although unusual, has been reported since 1834 when Davis published the first bullet embolus. Our case was a 29-year-old woman who suffered from a grenade explosion wound with a residual burst fragment inside her arm soft tissue. Two months later, she was admitted with progressive fatigue, palpitation, shortness of breath, and swelling in legs and neck. She was taking hormonal therapy for infertility as medical history. Ascultation detected holosystolic respiratory variable murmur maximal over the left lower sternal border. Severe tricuspid regurgitation and an obliterating mass on tricuspid valve (TV) with characteristic of central linear echogenicity were detected by transthoracic echocardiography. The diagnosis of "the embolized missile into heart with superimposed thrombosis" was determined. The patient underwent open heart surgery and the thrombotic rod shape chip that was embedded in anterior tricuspid leaflet was removed and then TV was repaired.

An Unusual Case of Needle Embolus Presenting With Delayed Spontaneous Pneumothorax

We report the case of a 39-year-old man presenting with an acute right-sided traumatic pneumothorax secondary to migration of a hypodermic needle fractured during intravenous drug use. We discuss the unusual passage of this foreign body from the left groin to the right ventricular wall and into the mediastinum, ultimately presenting with a right pneumothorax 1 year later.

Management of Accidental and Iatrogenic Foreign Body Injuries to Heart- Case Series

Accidental and iatrogenic foreign body injuries to heart require immediate attention and its timely management is cornerstone to the life of an individual. We describe in detail five cases of Accidental and iatrogenic foreign body injuries to heart encountered between January 2013 and July 2016. Our series included the following: needle stick injury to the right atrium (1 case) retained catheter fragments in the distal main pulmonary artery (1 case), right ventricle injury during catheterisation study (1 case), right ventricle injury during permanent pacemaker lead placement (1 case), device migration in atrial septal defect closure (1 case). Foreign bodies were removed from the cardiac cavities when the patient presented with features of infection (1 case), cardiac tamponade (2 case), anxiety (1 case), and haemodynamic instability (1 case). The management of accidental and iatrogenic foreign body injuries to heart requires immediate attention. Foreign bodies in the heart should be removed irrespective of their location and symptomatology. Asymptomatic foreign bodies diagnosed immediately after the injury with associated risk factors should be removed; asymptomatic foreign bodies without associated risks factors or diagnosed accidentally after the injury also need surgical intervention to allay fears of anxiety in patient and their relatives, to prevent any late complications and also for medico-legal purpose.

Needle embolism in intravenous drug abuse

Although intravenous drug users report the breaking of a needle as a relatively common occurrence, central embolism of needle fragments occurs infrequently in the literature. Central needle embolism also poses a conundrum for the radiologist, as the needle may be easily overlooked when the clinical history is nonspecific. We present two cases of needle embolism to the lung, one complicated by inflammatory mass and progressive pleuritic chest pain requiring wedge resection. We hope that our experiences may increase radiologists’ and emergency physicians’ familiarity with this unusual cause of chest pain. The radiological findings are subtle and may be easily overlooked, particularly without thorough clinical history.

Self-Inserted Needles in the Heart

Cardiac injuries due to penetration by sharp foreign bodies usually have a clear clinical presentation. A case of a 38-year-old man with self-inserted cardiac lesions and a misleading presentation is reported. The patient was admitted to the emergency room because of chest pain, with increase in biomarkers of myocardial necrosis, and electrocardiographic and echocardiographic abnormalities inducing initial diagnostic and therapeutic workup of acute coronary syndrome. Once clinical destabilization followed by death had occurred, the suspicion of an alternative diagnosis came from delayed chest radiography, confirmed by autopsy, revealing the presence of multiple metallic objects within the thorax.

Needle Migration to the Heart: An Unusual Association of Hemodialysis and Cardiovascular Morbidity

In this report, we present a unique complication of hemodialysis: the hemodialysis access needle was lost into an arteriovenous fistula. The event went unnoticed for several months. The needle eventually migrated into the right ventricle, requiring an operative retrieval. Loss of the needle was likely unrecognized because of the use of a retracting safety cannula that conceals the needle within a sheath after removal. This case highlights a rare and potentially serious complication of hemodialysis access, demonstrates a possible hazard of retracting safety needles, and reviews the management of foreign bodies that have migrated into the heart.

Constrictive Pericarditis Long after a Gunshot Wound

Constrictive pericarditis is an uncommon post-inflammatory disorder characterized by a variably thickened, fibrotic, and frequently calcified, pericardium. Etiology of the constriction can occur for many reasons. Although foreign bodies are not the common cause of constrictive pericarditis, the long-term presence of foreign bodies, like bullets, is presumed to cause chronic constrictive pericarditis even after a very long asymptomatic period. A 69-year-old patient with atrial flutter was admitted to the hospital. A cardiac computed tomography showed a bullet located adjacent to the right atrium. The transthoracic echocardiography showed a thickened pericardium and septal bouncing motion, which were compatible with constrictive pericarditis. The history of the patient revealed an injury by gunshot during the Korean War in 1950. Radiofrequency ablation of the atrial flutter was performed, and after ablation, the bullet was removed surgically. The patient was discharged home after surgery without complications.

Needle fragment embolism into the right ventricle: a rare cause of chest pain case report and literature review

Chest pain in young adults is usually self-limited and of benign etiology. However, rare causes of chest pain must be considered in patients for whom initial diagnostic tests are negative, particularly if unusual risk factors are identified. The authors present a rare case describing a 27-year-old male intravenous drug user who developed transient chest pain most likely secondary to pericardial irritation caused by a needle fragment that embolized from a peripheral vein to his right ventricle. The current literature on intracardiac needles and similar foreign bodies is discussed, providing insight to the epidemiology, complications, and treatment of such patients.

The story of the lost needle: Foreign body embolization to the heart

A 61-year-old female was evaluated because of severe symptomatic mitral regurgitation. She was found to have a foreign body in the heart by cardiac catheterization. Through a retrospective review of serial imaging studies, we found that a hypodermic needle had been retained in the body from a prior abdominal wall surgery and had subsequently migrated to the heart. During surgical mitral valve replacement the needle was identified and removed. We demonstrate the trajectory of this foreign body from the abdominal wall into the heart. <Learning objective: Foreign bodies can migrate from the subcutaneous tissue into the venous circulation and subsequently into the heart. A thorough surgical history is important in the evaluation of foreign bodies in the heart. An assessment of symptoms and future risk of complications should guide the removal of cardiac foreign bodies.>.

An unusual case of foreign body pulmonary embolus: case report and review of penetrating trauma at a pediatric trauma center

PURPOSE

Penetrating thoracic trauma is relatively rare in the pediatric population. Embolization of foreign bodies from penetrating trauma is very uncommon. We present a case of a 6-year-old boy with a penetrating foreign body from a projectile dislodged from a lawn mower. Imaging demonstrated a foreign body that embolized to the left pulmonary artery, which was successfully treated non-operatively.

METHODS

We reviewed the penetrating thoracic trauma patients in the trauma registry at our institution between 1/1/03 and 12/31/12. Data collected included demographic data, procedures performed, complications and outcome.

RESULTS

Sixty-five patients were identified with a diagnosis of penetrating thoracic trauma. Fourteen of the patients had low velocity penetrating trauma and 51 had high velocity injuries. Patients with high velocity injuries were more likely to be older and less likely to be Caucasian. There were no statistically significant differences between patients with low vs. high velocity injuries regarding severity scores or length of stay. There were no statistically significant differences in procedures required between patients with low and high velocity injuries.

CONCLUSIONS

Penetrating thoracic trauma is rare in children. The case presented here represents the only report of cardiac foreign body embolus we could identify in a pediatric patient.

Migration of a broken scalpel into the heart after spine surgery

Iatrogenic vascular problems during posterior lumbar interbody fusion are a rare entity. Migration of a broken scalpel towards the heart has, to our knowledge, never been reported. We present the successful surgical retrieval of a broken scalpel from the heart after posterior lumbar interbody fusion without the use of a cardiopulmonary bypass.

An unusual presentation of chest pain: needle perforation of the right ventricle

Foreign bodies in the heart are a rare occurrence and can result from intravenous drug abuse, trauma or iatrogenic causes. There are no current guidelines for the treatment of a cardiac foreign body. We hereby present a brief review of the available literature and report a case of a woman with chest pain subsequently complicated by cardiogenic shock due to tamponade secondary to a needle fragment perforating her right ventricular free wall.

Management of metallic foreign bodies in the heart

Management of the metallic foreign body in the heart remains controversial. Evaluation of possible methods for this issue and its possible treatments are discussed, the results of which may lead to a more effective strategy for management of intracardiac foreign bodies.

The curious case of a button which led to the needle

Foreign bodies in the heart are uncommon in children. These are often removed even if asymptomatic to prevent complications like erosion, embolization, bleeding, thrombosis, and endocarditis. We report the case of a one-and-a-half-year-old child with a hypodermic needle in the heart which was found incidentally and removed successfully by surgery.

Needle in the haystack: purulent pericarditis from injection drug use

Central needle embolization is a rare complication of intravenous drug abuse which has only been reported on a handful of occasions. Previously reported cases of needle embolization to the heart have been managed conservatively (observation alone) or by surgical intervention. We report a case of purulent pericarditis without evidence of valvular vegetations resulting from an embolized, infected needle fragment. In the present case, the needle was successfully removed from the right ventricle percutaneously. This case illustrates the unique finding of purulent pericarditis due to a persistent foreign body in the right ventricle, and the nontraditional intervention performed for needle fragment removal which resulted in full clinical recovery of the patient.

The needle and the damage done: pericardial effusion with tamponade after needle ingestion in an infant

OBJECTIVE

Paediatric foreign bodies may present with vague and nonspecific symptoms. It is important to have a high index of suspicion when managing such cases.

METHOD

We report the case of a nine-month-old infant who presented with a wheeze, cough and fever following ingestion of a needle.

RESULTS

This patient developed pericardial tamponade as a consequence of the needle ingestion, and required a thoracotomy for retrieval. We discuss the pathophysiology involved and the surgery required.

CONCLUSION

Pericardial tamponade is a rare but potentially fatal manifestation of an ingested foreign body.

Pediatric penetrating cardiac injury from abuse: a case report

While cardiac foreign bodies after trauma have been described in the literature, we report the first case of intentional injury in an infant with an intracardiac needle. We review the literature and stress the need for a high degree of vigilance in evaluating children for potential child abuse.

Chronic Heart Perforation With 13.5 cm Long Kirschner Wire Without Pericardial Tamponade: An Unusual Sequelae After Shoulder Fracture

We report a unique case of cardiac embolization with the Kirschner wire that has been used for osteosynthesis for 24 months previously. According to the complete analysis of medical records and autopsy report, the wire had migrated from the right humeroscapular joint to the heart. Although migration of a Kirschner wire has been reported in the literature, migration of the wire with a total length of 13.5 cm with no pericardial tamponade, despite myocardial perforation, has not been previously described.

Intramyocardial foreign body: sewing needle with the uncommon clinical feature of constrictive pericarditis

A rare case of intracardiac injury with a sewing needle causing constrictive pericarditis is reported. A 72-year-old woman was admitted with edema of the face and legs. A chest radiogram showed a needle-shaped metallic image overlying the cardiac silhouette. Computed tomography revealed the needle was located in the left ventricular myocardium, and also showed a thickened pericardium. Surgical removal of the needle and pericardectomy were performed simultaneously.

Cardiac tamponade caused by migration of a swallowed sewing needle

The case of a 20-year-old female prisoner who died due to cardiac tamponade caused by a swallowed sewing needle migration is reported. According to the autopsy report and complete analysis of medical records, the migration of the swallowed needle was reconstructed: from esophagus and stomach, through diaphragm and pericardium up to the left heart ventricle, where the needle was found at the autopsy. The case is very interesting and unique: there has been no similar case described in medical literature so far.

Pericarditis

Pericarditis is a common disorder that has multiple causes and presents in various primary-care and secondary-care settings. New diagnostic techniques have improved the sampling and analysis of pericardial fluid and allow comprehensive characterisation of cause. Despite this advance, pericarditis is most commonly idiopathic, and radiation therapy, cardiac surgery, and percutaneous procedures have become important causes. Pericarditis is frequently self-limiting, and non-steroidal anti-inflammatory agents remain the first-line treatment for uncomplicated cases. Integrated use of new imaging methods facilitates accurate detection and management of complications such as pericardial effusion or constriction. Differentiation of constrictive pericarditis from restrictive cardiomyopathy remains a clinical challenge but is facilitated by tissue doppler and colour M-mode echocardiography. Most pericardial effusions can be safely managed with an echo-guided percutaneous approach. Pericardiectomy remains the definitive treatment for constrictive pericarditis and provides symptomatic relief in most cases. In the future, the pericardial space might become a conduit for treatments directed at the pericardium and myocardium.

Posttraumatic and iatrogenic foreign bodies in the heart: report of fourteen cases and review of the literature

OBJECTIVE

Our experience with posttraumatic and iatrogenic foreign bodies in the heart is presented and discussed along with a review of the literature on this subject.

SUMMARY BACKGROUND DATA

Posttraumatic or iatrogenic foreign bodies in the heart can be treated either conservatively or surgically. Controversy exists about optimal management.

METHODS

Fourteen cases of posttraumatic or iatrogenic foreign bodies in the heart observed between 1955 and 2000 were studied. Our series includes the following: bullets into the right or left ventricle (4 cases); needles in the left ventricle, atrium, and pulmonary artery (3 cases); retained catheter fragments in the right ventricle, right atrium, or in the pulmonary artery (4 cases); a grenade fragment into the right atrium (1 case); a circular saw fragment into the right ventricle (1 case); and a commissurotomy ring into the left atrium (1 case).

RESULTS

Foreign bodies were removed when in the cardiac cavities (1 case); when in the presence of associated risk factors like embolism, arrhythmia, or infection (3 cases); and when in the presence of associated signs or symptoms including cardiac tamponade (2 cases), arrhythmia (1 case), fever (2 cases), or anxiety (1 case). Removal was accomplished by a thoracotomy (7 cases) or sternotomy (2 cases), with (3 cases) or without cardiopulmonary bypass, or percutaneously (1 case). Four asymptomatic patients were conservatively treated and have no evidence of complications at a median follow-up of 20 years.

CONCLUSIONS

The management of foreign bodies in the heart should be individualized: (1) symptomatic foreign bodies should be removed irrespective of their location; (2) asymptomatic foreign bodies diagnosed immediately after the injury with associated risk factors should be removed; (3) asymptomatic foreign bodies without associated risks factors or diagnosed late after the injury may be treated conservatively, particularly if they are completely embedded in the myocardium or in the pericardium.

Intravenous drug users and broken needles--a hidden risk?

AIMS

To determine the frequency with which intravenous drug users (IDUs) experience broken needles during their injecting careers.

DESIGN

Cross-sectional survey.

PARTICIPANTS

Seventy intravenous drug users held in police custody in Bristol between May and September 2002.

MEASUREMENTS

Self-reported history of experience of broken needles.

FINDINGS

Fourteen (20%, 95% CI 11-29%) had experienced a needle breaking while injecting. The total number of broken needles was 23, of which 14 (61%) were recovered, four by surgical intervention, and the remainder as a result of direct action by the individual. Of the 23 broken needles, nine (39%) were reported to be fresh needles, whereas the remainder were being re-used.

CONCLUSIONS

IDUs may well experience, directly or indirectly, incidents involving broken needles during the course of their injecting careers. Given the potential for embolization and the risk of subsequent complications when this occurs, we recommend that harm minimization guidance should include advice about this potential hazard and the need for early action to retrieve broken needles.

Pericardial foreign body

The authors describe the case of an inhaled foreign body unusually located in the pericardium. An initial chest skiagram was misinterpreted leading to a negative bronchoscopy. Correct anatomic localization of the foreign body only was established at surgical exploration, despite preoperative computerized tomography scan of the chest. Recognition of the propensity of sharp foreign bodies to migrate is essential in treating these patients. A tracheobronchial foreign body migrating to the pericardium has not been reported previously in the literature. J Pediatr Surg 36:936-938.