Percutaneous Removal of a Tiny Needle Fracture From the Right Ventricle of the Heart in a Drug Abuser

Bompotis, Georgios; Karkanis, Georgios; Chatziavramidis, Angelos; Konstantinidis, Iordanis; Dokopoulos, P.S.; Lazaridis, Ioannis; Pyriochos, Panagiotis D

doi:10.1177/1538574416680979

Cited by 8 publications

(5 citation statements)

References 9 publications

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“…Depending on location and accessibility, endovascular, percutaneous, thoracoscopic, or thoracotomy approaches might be utilized. Alternatively, with any evidence of intracardiac penetration, the safest approach involves sternotomy with or without the use of cardiopulmonary bypass [29][30][31]. From the literature, there are general guidelines regarding indications for surgical intervention.…”

Section: Resultsmentioning

confidence: 99%

Intracardiac Self Insertion of a Darning Needle in a Psychiatric Patient

Laarakker¹

2021

JCCI

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Objective: We report a case of self inserted needle into the left ventricle of the heart and a description of our surgical intervention in a psychiatric patient without decision-making capacity. We discuss issues regarding obtaining consent in this patient with a sub-acute presentation, report our operative approach, and summarize a treatment approach based on a review of current literature. Methods: A PubMed search using terms “needle, “heart”, “insertion”, “intracardiac foreign object”, yielded 69 relevant papers. 67 of these were case reports yielding 72 individual cases. Age, gender, cause of the needle entry (Accidental Plus (A+), Intravenous Drug User [IVDU], Self-inflicted (SI)), type of needle, location in heart, neuropsychiatric history, treatment, and outcome were documented. Results: Within the SI category, there were a total of 28 cases, 89.3% had a neuropsychiatric history whereas only there were only 2 such patients in both the IVDU and A+ group. The location of the needle in the heart in all 72 cases was as follows: right ventricle 40.3%, other 20.8%, left ventricle 19.4 %, ventricle and interventricular septum 16.7% and the right and left atrium were each 1.4 %. In all three groups (n=72), 77.8% of patients underwent surgery, with 92.9% having a stable outcome. Conclusion: Our case and review demonstrates that management of such cases, particularly when active mental health issues are present, requires a case-by-case evaluation and treatment as a specific standard of care has not been established. Surgical intervention appears to be the preferred management regardless of presentation with good outcomes. Running Title: Intracardiac Self Insertion of a Darning Needle in a Psychiatric Patient

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Section: Resultsmentioning

confidence: 99%

Intracardiac Self Insertion of a Darning Needle in a Psychiatric Patient

Laarakker¹

2021

JCCI

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“…Repeated injection may result in a needle fracturing in the user's body [2, 26, 38]. If the needle is retained in soft tissue, an inflammatory capsule may form around it, encapsulating it in scar tissue.…”

Section: Resultsmentioning

confidence: 99%

Radiographic Musculoskeletal Findings Indicating Opioid Misuse: An Overview for Orthopedic Surgeons

et al. 2019

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Background: Given the high prevalence of musculoskeletal conditions in the USA, it is important for orthopedic surgeons to promptly identify patients who may be at risk for opioid misuse. Questions/Purposes: The aim of this literature review was to elucidate various musculoskeletal pathologies and complications, as seen on imaging, that may indicate opioid misuse or opioid use disorder. Methods: A literature search was conducted using the PubMed, Scopus, and Cochrane Library databases for articles related to imaging findings associated with chronic opioid use or misuse in orthopedic patients. Two independent reviewers conducted the search utilizing pertinent Boolean operations. Results: We reviewed 36 full-text articles and categorized the radiographic evidence of opioid misuse as follows: soft-tissue radiologic findings, cellulitis, necrotizing fasciitis, abscess formation, retained needles, discitis, myopathy and rhabdomyolysis, osteomyelitis, septic arthritis, and septic thrombophlebitis. Conclusion: Knowledge of the radiologic findings of opioid misuse will assist orthopedic surgeons in making timely diagnoses that may alter therapeutic regimens for their patients.

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“…An alternative therapeutic option for removal of foreign bodies from the heart is the percutaneous approach, with the use of a guidewire through the femoral vein and a magnet at its distal end. This is applicable only for small, intracavitary foreign bodies [10]. The management of foreign bodies in the heart should be individualized: (1) symptomatic foreign bodies should be removed, no matter their location; (2) asymptomatic foreign bodies diagnosed immediately after the injury with a high risk of infection, embolization, or erosions should be removed; (3) asymptomatic foreign bodies without associated risk factors or diagnosed late after the injury may be treated conservatively, particularly if they are completely embedded within the myocardium or the pericardium [5].…”

Section: Case Presentationmentioning

confidence: 99%

“…To our knowledge, only a few cases of needle embolization in pulmonary vasculature or inside the right heart are reported in the literature, most of them in drug abusers or after iatrogenic accidents [9][10][11][12][13][14][15].…”

Section: Case Presentationmentioning

confidence: 99%

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

et al. 2020

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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.

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Percutaneous Removal of a Tiny Needle Fracture From the Right Ventricle of the Heart in a Drug Abuser

Abstract: This percutaneous technique for the removal of a tiny foreign body from the heart was proven to be both effective and safe for the patient, and it provides a good therapeutic option for removal of intracardiac foreign bodies.

Cited by 8 publications

References 9 publications

Intracardiac Self Insertion of a Darning Needle in a Psychiatric Patient

Intracardiac Self Insertion of a Darning Needle in a Psychiatric Patient

Radiographic Musculoskeletal Findings Indicating Opioid Misuse: An Overview for Orthopedic Surgeons

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

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