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Retained hypodermic needles in the neck.


A 42-year-old man with hepatitis C presented to the emergency department with fever and a tender, fluctuant neck mass on the right. He had a well-documented history of intravenous heroin use, which caused him to undergo multiple incisions and drainages of peripheral abscesses.

Contrast-enhanced computed tomography (CT) of the neck detected an abscess and evidence of several metallic foreign bodies that appeared to be broken fragments of hypodermic needles (figure). The patient was emergently taken to the operating room for incision and drainage Incision and drainage is a minor surgical procedure to release pus or pressure built up under the skin, such as from an abscess or boil. It is performed by treating the area with an antiseptic, such as iodine based solution, and then making a small incision to puncture the skin  of the abscess and admitted for treatment with intravenous antibiotics. Cultures were consistent with oxacillin-resistant Staphylococcus aureus, requiring 2 weeks of vancomycin. However, the patient left the hospital against medical advice prior to the completion of his antibiotic regimen.

[FIGURE OMITTED]

When peripheral veins become sclerosed scle·rosed  
adj.
1. Affected by sclerosis; hardened.

2. Botany Lignified.



[From sclerosis.]

Adj. 1.
 as a result of a long history of injections, end-stage intravenous drug abusers often resort to injecting substances into deep cervical neck veins. Abusers call such an injection a "pocket shot," referring to the pocket between the sternal sternal /ster·nal/ (ster´n'l) of or relating to the sternum.

ster·nal
adj.
Of, relating to, or occurring near the sternum.



sternal

pertaining to the sternum.
 and clavicular clavicular adjective Pertaining to the clavicle  heads of the sternocleidomastoid muscle. The complications of this maneuver can be severe and life-threatening. Infectious complications include abscess formation, cellulitis, mycotic aneurysms, and clavicular osteomyelitis. (1) Other reported adverse effects include vocal fold paralysis, pneumothorax pneumothorax (nmōthôr`ăks), collapse of a lung with escape of air into the pleural cavity between the lung and the chest wall. The cause may be traumatic (e.g. , internal jugular vein internal jugular vein
n.
A vein that is a continuation of the sigmoid sinus of the dura mater and unites behind the cartilage of the first rib with the subclavian vein to form the brachiocephalic vein.
 thrombosis, and foreign-body embolus embolus (ĕm`bələs), foreign matter circulating in and obstructing a blood vessel. It may be a portion of a clot that has separated from the wall of a vessel (see thrombosis), a bubble of gas or air (known as an air embolus), a globule of  formation resulting in cardiac and pulmonary complications. (2-5)

Many intravenous drug abusers reuse needles dozens of times. As a result of repeatedly bending the needle into the desired configuration and given the difficulty of self-injecting deep cervical neck veins, it should be no surprise that retained broken needles are common in this population. Any such patient with a complication of deep cervical injection should undergo proper imaging studies to assist in surgical planning and to reduce the risk of accidental needle stick to the surgical team.

References

(1.) Williams MF, Eisele DW, Wyatt SH. Neck needle foreign bodies in intravenous drug abusers. Laryngoscope 1993;103:59-63.

(2.) LeMaire SA, Wall MJ Jr., Mattox KL. Needle embolus causing cardiac puncture and chronic constrictive pericarditis. Ann Thorac Surg 1998;65:1786-7.

(3.) Brunette DD, Plummer DW. Pulmonary embolization of needle fragments resulting from intravenous drug abuse. Am J Emerg Med 1988;6:124-7.

(4.) Hillstrom RP, Cohn AM, McCarroll KA. Vocal cord paralysis Vocal Cord Paralysis Definition

Vocal cord paralysis is the inability to move the vocal cords and the resulting loss of vocal cord function.
Description
 resulting from neck injections in the intravenous drug use intravenous drug use Intravenous drug abuse The habitual IV injection of drugs of abuse Epidemiology In the US ± 2.5 million–population ± 235 million have used IVDs Infections Pyogenic–eg, endocarditis, pneumonia, sepsis Common agents  population. Laryngoscope 1990;100:503-6.

(5.) Lin D, Reeck JB, Murr AH. Internal jugular vein thrombosis and deep neck infection from intravenous drug use: Management strategy. Laryngoscope 2004;114:56-60.

Michael J. Rodriguez, MD; Simon Angeli, MD

From the Department of Otolaryngology, University of Miami School of Medicine.
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Title Annotation:IMAGING CLINIC
Author:Angeli, Simon
Publication:Ear, Nose and Throat Journal
Geographic Code:1USA
Date:Mar 1, 2006
Words:430
Previous Article:Vocal fold hemorrhage observed during laryngoscopy.(LARYNGOSCOPIC CLINIC)
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