Chest wall necrosis and empyema resulting from attempting suicide by injection of petroleum into the pleural cavity

Abstract

Hydrocarbon poisoning such as that of benzene and petroleum usually occurs accidentally by inhalation or ingestion of these cytotoxic chemical compounds. Intravenous or subcutaneous injection of petroleum compounds with intent of suicide or abuse is an extraordinary event that can result in local damage or systemic toxicity such as tissue necrosis, abscess formation, respiratory system failure and partial damage to the kidneys, the brain and the nervous system. In this article, we describe a 31-year-old man who was admitted in the surgery ward of Besat Hospital. He had widespread necrosis and infection of the chest wall soft tissue and also had empyema after a suicidal attempt by injection of 40 ml of petroleum into the left hemithorax. The patient underwent repeated surgical debridement of the chest wall necrotic tissues. With segmentectomy and flap reconstruction of the chest wall wound, he recovered completely and was discharged. Our report supports early and aggressive surgical debridement of necrotic tissue, thoracotomy tube insertion and special care of respiratory system toxicity after chest wall injection of petroleum. Regarding the basis of clinical findings and paraclinical investigations that measure lung parenchymal necrosis with empyema and fistula formation, thoracotomy and decortication with or without lung tissue resection and also chest wall reconstruction are the standard treatment of these patients.

Thoracic empyema and pectoral abscess resulting from attempting suicide by injection of benzene in the pleural cavity

“…Bronchopleural fistulas are also a frequent complication of intrathoracic injections of hydrocarbon compounds. In the report of Eskandarlou et al [ 6 ] a similar case was presented and they needed frequent surgical procedures and debridements and eventually a segmentectomy and chest wall reconstruction due to the empyema and bronchopleural fistulas formed after such a intoxication attempt.…”

“…Hydrocarbon poisoning can lead to thoracic pathology in rare cases [ 5 , 6 ]. Hydrocarbons include three major groups; aliphatics, aromatics and halogenics.…”

“…The most affected organ system is the respiratory system and the cytotoxic effects of hydrocarbons can manifest as respiratory failure, pneumonitis and even acute respiratory distress syndrome (ARDS) [ 1 , 7 ]. Subcutaneous injection of hydrocarbon compounds can cause swelling, redness, tenderness, crepitation and abscess formation according to the volume, the depth and the impregnation time after the injection [ [1] , [2] , [3] , [4] , [5] , [6] , [7] , [8] , [9] ].…”

Breast Necrosis Following Coronary by Pass Graft Surgery: Report of Two Cases & Review of Literature

“…Chest wall necrosis due to self inflicting trauma using variable chemicals or extensive chest wall infections have been reported [6] Drugs such as warfarin has been incriminated in a subset of patients as a cause of skin necrosis and the chest wall is no exception [7].…”

Chemical pneumonitis arising from deliberate intravenous administration of white spirit (Stoddard solution)

“…3,5,6 Patients almost always have chest pain and frequently have haemoptysis and dyspnoea which may erroneously lead to an associated or differential diagnosis of pulmonary embolism although there are no reported cases of intravenous hydrocarbon resulting in pulmonary embolism. Death has been reported with volumes as small as 5 mL due to severe lung injury despite patients receiving cardiovascular and respiratory support in an intensive care setting.…”