Discussion:
Intravenous drug users may experience needle breaking incidences during
their self-injection. (5) The time taken for needles to migrate from
soft tissues and embolize centrally can vary from a matter of a few
hours to several days (6). Needle embolization to the lung is rarely
reported in intravenous drug abusers, and most of the reported cases of
needle embolization were iatrogenic embolization after the vascular
intervention.
Richardson and colleagues performed a literature review of over 200
patients who had embolization of catheter fragments. They identified
embolization to the lung periphery in eight cases; none of them required
treatment. (7)
Needle breaking is common in intravenous drug users, but under-reported.
In a survey among intravenous drug users, one-fifth of participants
reported a needle breaking during drug injection, many of which could
not be surgically or individually recovered. (5) Among eight patients of
pulmonary needle embolism, Hart and co-workers reported seven cases with
right lung embolization (8). In agreement with most of the reported
embolization to the lung, our patient had embolization to the right
lung.
Needle embolization to the heart was associated with pericarditis,
endocarditis, and pulmonary abscess (9). However, most cases of needle
embolization to the lung were not associated with complications. One
patient with needle embolization to the lung presented with organized
pneumonia with staph aureus (1).
Because of the stigmata of drug abuse, patients with broken needles may
be reluctant to seek medical advice. Patients may present later with
pulmonary complications such as infection or pneumothorax, and prior
awareness of this condition could lead to the diagnosis of the cause.
Migration of foreign bodies outside the lung has been previously
reported (10), and needle embolization should be suspected in all
pulmonary foreign bodies.
There is no standard medical management for pulmonary needle embolism
reported in the literature. We discharged the patient on low dose
Aspirin for fear of thrombosis on top of the foreign body. The role of
antiplatelet medications in these cases is not known, and there are no
recommendations against or with the use of them in needle pulmonary
embolization. The patient remained symptom-free, and no complications
were reported after six months of follow-up.