A rare case of pulmonary embolism caused by a needle fragment 22 years after penetrating forearm injury: a case report

Introduction: Foreign-body embolism is a rare cause of pulmonary embolism. In this case report, we describe an unusual case of foreign-body pulmonary embolism that became symptomatic 22 years after an initial penetrating forearm injury caused by a needle. Case presentation: The patient was a 53-year-old man who had presented with a 2-week history of cough, hemoptysis, and flu-like symptoms prior to his admission to our center. Initially, a chest X-ray revealed evidence of a foreign body, most likely a needle, located in the right lower lobe of the lung. The patient reported a history of needle penetration 22 years earlier, during which a needle had penetrated the anterior aspect of his left forearm. A spiral chest computed tomography (CT) scan without contrast revealed a dense foreign body measuring 21 mm in diameter, with an associated intravascular metallic artifact located within the posterobasal branch of the right lower lobe. Discussion: An interesting and unusual aspect of this patient was that he became symptomatic 22 years after the initial trauma. The chest X-ray was helpful in raising the initial suspicion and prompting further clinical investigation of pulmonary artery foreign-body embolism, while the chest CT scan was used for more precise localization of the needle to guide subsequent management and potential intervention. Conclusion: Although most foreign-body embolism cases become symptomatic shortly after penetration, in rare cases the foreign body may take decades to mobilize and cause symptoms.