A 34-year-old intravenous drug user complains of right-sided neck and chest pain. You see swelling at the base of his neck, and he admits to hiring the services of a “street doc” to shoot into his deep neck veins. Which of the following statements regarding “pocket shots” is true?
Sternoclavicular septic arthritis has not been described as a potential complication.
+Aneurysms have resulted from this practice.
+These patients can be safely discharged on antibiotics after emergency department incision and drainage.
+Ischemic necrosis of the sternocleidomastoid muscle secondary to compartment syndrome has been described.
+Tracheal deviation away from the swelling should prompt treatment of a contralateral pneumothorax.
The sternoclavicular joint and spine are frequent sites of skeletal infection in addicts, often by Pseudomonas and other uncommon causes of septic arthritis. Deep neck abscesses are not uncommon in these patients, but mycotic aneurysm must be excluded as a cause of a mass located near major vessels. A compartment syndrome would not occur in the sternocleidomastoid muscle because it is not in a fascial compartment. Thrombophlebitis is an obvious complication of intravenous drug use. Septic emboli from tricuspid valve endocarditis causes chest pain, but if there is associated neck swelling and tenderness, septic thrombophlebitis are also likely. Pneumothorax is commonly seen in neck shooters. Tension pneumothorax results in tracheal deviation away from the affected side. In addicts less adept at self-administration, bilateral tension pneumothoraces is possible. These patients may present in respiratory or cardiovascular distress.