Left ventricular perforation from a dislodged needle migrating via a pulmonary artery branch in an intravenous drug user

Postmortem Imaging of an Unusual Case of Fatal Heart and Lung Perforation Due to Self-Treatment

Intentional or accidental cardiothoracic injuries caused by needles and pins are rare and commonly reported in individuals with psychiatric conditions or intravenous drug users. Although rare, these cases could result in serious injury during the performance of an autopsy and highlight the importance of post-mortem radiology. Therapeutic complications with cardiac perforation have been reported due to pericardiocentesis and acupuncture. The majority of reported cases were not fatal and some had a prolonged asymptomatic period of weeks or even years after insertion. Needles or other sharp objects can reach the cardiovascular system directly through the chest wall, indirectly from any segment of the gastrointestinal tract after swallowing needles, or through migration of broken needles from distant injection sites in intravenous drug users. We report a case of rapidly fatal cardiopulmonary injuries following "self-treatment" to "pop" a cyst with a piercing needle. The scene, autopsy, computed tomography, and digital x-ray findings of this unique case are discussed with a review of selective literature. In this case, the right lung and heart showed multiple perforations, possibly resulting from heartbeats or respirations pushing the organs against the needle. To our knowledge, perforations in this setting of "self-treatment" have not been previously reported in the literature.

Chronic unilateral groin pain in a young patient who injects drugs: a case report of needle fragment retentions

BACKGROUND

Subcutaneously retained needle fragments in people who inject drugs (PWIDs) are a possible cause of local symptoms, most commonly pain and infections. It remains unknown how common retained needle fragments are among PWIDs.

CASE PRESENTATION

A young PWID consulted a primary care physician due to chronic left-sided groin pain. The patient suspected retention of a broken needle as the cause. She had used a re-used needle 3 months earlier. A plain pelvic radiograph confirmed a needle fragment in the patient's left groin, and a computed tomography scan located it adjacent to the femoral artery and vein. Another asymptomatic needle fragment was found in the right groin.

CONCLUSION

Needle fragments are possible causes of local symptoms among PWIDs. The clinical examination presents a potential risk of needlestick injury to the examiner, especially because patients may not be aware of all needle fragments as some are asymptomatic.