SPEEDBALLING WITH NEEDLE EMBOLIZATION - CASE-STUDY AND REVIEW OF THE LITERATURE

Foreign-body embolization is not an uncommon occurrence. However, to o ur knowledge, there are only ten reported cases of needle embolization associated with intravenous drug use. We report the sudden death of a 49-year-old white male with a known history of crack cocaine abuse. A t autopsy, suspicious needle marks were noted on the right lower extre mity. The lungs were of increased weight at 1000 and 1090 g and appear ed edematous. The heart weighed 520 g and had a normal red-brown myoca rdium. Upon sectioning, a broken hypodermic needle of very small calib er was identified in the right ventricular myocardium protruding into the right ventricular chamber. This needle apparently traveled from th e injection site to the right ventricle. The right ventricle was dilat ed and hypertrophied. and microscopic examination showed hyperemic myo cardium surrounding the needle. Sections of lung showed numerous forei gn-body type giant cells containing polarizable foreign material consi stent with intravenous drug use. Toxicological analysis revealed the p resence of ethanol (36 mg/dL), cocaine (0.098mg/L), benzoylecgonine (2 .16 mg/L), and morphine (0.841 mg/L). Urine and blood were positive fo r the presence of 6-monoacetylmorphine. Based on the toxicological ana lysis, the cause of death was determined to be cocaine and heroin toxi city, and the manner accidental. The needle embolus was considered an incidental finding.