Left ventricular perforation from a dislodged needle migrating via a pulmonary artery branch in an intravenous drug user.

Embolised needles causing injury to the right heart and cardiac tamponade has been reported before in intravenous drug users, but to our knowledge, this is the first reported case of a needle migrating via the pulmonary arterial system to cause perforation of the left ventricle. Appropriate utilisation of imaging modalities such as plain X-ray and point-of-care focused cardiac ultrasound can be vital and life-saving in the emergency setting, and the value of gated multidetector CT as a powerful tool for imaging moving structures is highlighted. © BMJ Publishing Group Limited 2020. No commercial re-use. See rights and permissions. Published by BMJ.