Fever with dyspnea and swollen bilateral subclavicular area in a drug addict.

A 32 year old drug-addicted male who was also a heavy smoker was admitted to the department of medicine with shortness of breath and non-specific chest pains that had begun a week previously. His medical history was unremarkable. Physical examination revealed a temperature of 37.78C and swollen bilateral subclavicular areas in addition to needlepuncture signs. Swelling and signs of needle infiltration were also seen in the bilateral upper limbs. The chest X-rays here show two needle-like materials. Ultrasonography confirmed the presence of intrasubclavian needle-shaped hyperechogenicity, as shown below. Ventilation-perfusion scans confirmed bilateral multiple pulmonary embolisms. Venous ultrasonography and venogram excluded the presence of deep vein thrombosis in the upper and lower extremities. After needle extraction and treatment for 6 months with an anticoagulant, there were no findings at ultrasonography or ventilation-perfusion scans performed 3 and 6 months after operation.