MR Findings of Alprazolam Injection into the Femoral Artery with Microembolization and Rhabdomyolysis

Abstract

Intravenous drug abuse unfortunately remains an extremely common problem worldwide, accounting for innumerable medical issues ranging from the transmission of human immunodeficiency virus (HIV) and other blood-borne diseases to skin necrosis to vasculitis to death [1]. We present a case of intra-arterial injection of alprazolam into the right femoral artery resulting in microembolization, acute ischemia and rhabdomyolysis of the thigh, as documented by magnetic resonance (MR) and laboratory findings.

Keywords: ED, emergency department; FSE, fast spin echo; HIV, human immunodeficiency virus; IV, intravenous; MR, magnetic resonance; STIR, short tau inversion recovery.

Figure 1

Axial tau fast spin echo (FSE) of the right thigh demonstrating normal musculature with extensive subcutaneous and subfascial edema. [Powerpoint Slide]

Figure 2a

Axial STIR images of the right thigh in axial planes demonstrating extensive high signal abnormality in the adductor, anterior, and posterior compartments, representing edema and ischemia from alprazolam microembolism. [Powerpoint Slide]

Figures 2 b-c

STIR images of the right thigh in axial planes demonstrating extensive high signal abnormality in the adductor, anterior, and posterior compartments, representing edema and ischemia from alprazolam microembolism. [Powerpoint Slide]

Figure 2d

Coronal STIR image of the right thigh in coronal planes demonstrating extensive high signal abnormality in the adductor, anterior, and posterior compartments, representing edema and ischemia from alprazolam microembolism. [Powerpoint Slide]