Foster Sean D, Lyons Michael S, Runyan Christopher M, Otten Edward J
Department of Emergency Medicine, University of Cincinnati, Cincinnati, Ohio, USA.
Department of Plastic, Reconstructive & Hand Surgery, University of Cincinnati, Cincinnati, Ohio, USA.
World J Emerg Med. 2015;6(3):233-6. doi: 10.5847/wjem.j.issn.1920-8642.2015.03.014.
Inadvertent intra-arterial injection of illicit substances is a known complication of injection drug use and can lead to severe complications, including infection, ischemia and compartment syndrome. Identifying complications of intra-arterial injection can be difficult, as clinical manifestations overlap with other more common conditions such as cellulitis and soft tissue infection, and a history of injection drug use is frequently not disclosed.
A 37-year-old male patient presented with 24 hours of right hand pain, erythema and swelling. Despite classic "track marks", he denied a history of injection drug use, and vascular insults were not initially considered. After failing to respond to three days of aggressive treatment for suspected deep-space infection, an arteriogram demonstrated findings consistent with digital ischemia of embolic etiology.
As a result of the delay in diagnosis, the lesion was not amenable to reperfusion and the patient required amputation of the distal digit.
Practitioners should be alert to the possibility of intra-arterial injection and resulting complications when evaluating unusual extremity infections or unexplained ischemic symptoms, even in the absence of a definite history of injection drug use.
意外动脉内注射非法药物是注射吸毒已知的一种并发症，可导致严重并发症，包括感染、缺血和骨筋膜室综合征。识别动脉内注射的并发症可能很困难，因为临床表现与其他更常见的疾病如蜂窝织炎和软组织感染重叠，而且经常不透露注射吸毒史。
一名37岁男性患者出现右手疼痛、红斑和肿胀24小时。尽管有典型的“针痕”，但他否认有注射吸毒史，最初未考虑血管损伤。在对疑似深部感染进行三天积极治疗无效后，血管造影显示结果与栓塞性病因导致的手指缺血一致。
由于诊断延误，病变无法进行再灌注治疗，患者需要截除远端手指。
在评估不寻常的肢体感染或不明原因的缺血症状时，即使没有明确的注射吸毒史，医生也应警惕动脉内注射及其并发症的可能性。
