Extravascular heroin injection causing neuropathy: ultrasound picture

Self-injection of heroin is a common behavior of drug addicts. In these cases, extravascular heroin dissemination may occur and the injected solution can cause a local damage to anatomical structures. In general, direct and indirect effects of injected materials may produce nerve injury: the former due to needle action or drug toxicity for the nerve elements; the latter due to produced local inflammation [1, 2]. Symptoms, signs and neurophysiological findings of the injection-mediated neuropathy reflect the nerve damage, with motor and/or sensory involvement. Besides clinical and neurophysiological evaluation, ultrasound (US) is a very useful tool to assess nerves. In fact, this technique is able to give information about anatomy and morphological alterations of peripheral nervous system [3, 4]. No cases of heroin-mediated neuropathy assessed by US are present in the literature.