Needle embolism in intravenous drug abuse

Abstract

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.

Keywords: CT, computed tomography; IVDU, intravenous drug use.

Figure 1

28-year-old man with needle embolism. Frontal and lateral radiographs of the chest demonstrate a thin linear radiodensity in the right midlung.

Figure 2

28-year-old man with needle embolism. Multiplanar reconstruction CT of the chest in lung windows (WL/WW -500/1400) shows the thin linear radiodensity extending from a segmental pulmonary artery into peripheral lung parenchyma (arrow).

Figure 3

28-year-old man with needle embolism. Axial image from pulmonary embolism protocol CT of the chest in bone windows (WL/WW 300/1500) demonstrates a linear radiodensity within an irregular consolidation in the peripheral right middle lobe (arrow).

Figure 4

28-year-old man with needle embolism. Frontal radiograph of the chest, A, Full field of view. B. 10X enlargement of right lung region of interest reveals a linear radiodensity in the right mid-lung (arrow) with faint surrounding consolidation.