Abstract 10425: Needle Fragment Embolization Leading to Cardiac Tamponade

Abstract

Background: Intravenous drug use (IVDU) may rarely result in needle embolism (1). We present a patient with history of active IVDU who was found to have pericardial effusion causing tamponade from needle fragment embolization. Case: 41-year-old female with history of active fentanyl use presented with pleuritic chest pain and dyspnea. EKG was consistent with acute pericarditis and she was started on colchicine and ibuprofen with symptomatic improvement. CT scan of the chest revealed a linear radiopaque structure along the inferior margin of pericardium (Figure 1). She had asymptomatic hypotension and echocardiogram showed moderate sized pericardial effusion with early signs of cardiac tamponade. She underwent median sternotomy and surgical evacuation of~400 ccs of hemopericardium and retrieval of intrapericardial needle fragment with anterior right atrial exit site. She did well post-operatively. She had previously presented 10-months prior with neck pain and lateral radiograph of the neck showed a needle fragment over the distal cervical trachea (Figure 2). Patient left against medical advice prior to treatment. Decision Making: Pericardiocentesis was deferred and surgical alternative was chosen after multidisciplinary discussion as she was asymptomatic and there was concern for ongoing bleeding from the needle exit site. Treatment options include conservative clinical monitoring in asymptomatic patients, pericardiocentesis/pericardial window, and surgical exploration of the mediastinal cavity (1). Conclusion: We describe a case of needle fragment embolization leading to cardiac tamponade requiring surgical evacuation and retrieval of foreign body.