Heroin abscess

‘Skin-popping’ is the injection of drugs, usually but not exclusively heroin, into the subcutaneous tissues.  This is typically done when the IV drug abuser has no more accessible veins, but is still addicted, so in the needle goes.

To say these injections are usually not done under the most sterile conditions would be an understatement.  The resulting infections are legendary, and every EM doctor and experienced nurse will have a story, or 10, about the worst they’ve seen.

The patients usually present incredibly ill and very miserable.  In my experience, they will have continued skin popping until the infection is so overwhelming they can no longer avoid going to the ER.  That their suffering is self-inflicted is a given, but we’re not there to judge, we’re there to do the job.

Today one of those patients presented, as described above, and xrayed below:


Those of you who see xrays for a living are probably squirming, as we did, on seeing this image, and for those who don’t, I’ll put an annotated picture in the extended entry.

To the OR for a very big drainage.

Oh, and the Throckmorton sign doesn’t work if the patient cannot lie flat.



  1. I don’t read xrays for a living, but I’ve seen a lot of them — never one that looked like that. I was hoping I was wrong about what that dark area was. It must take a lot of narcotics to control the pain in someone who’s clearly used to whopping doses just to keep from withdrawing. One more reason I don’t understand why people think NICU is in any way exceptional. Our patients don’t do this stuff. Not for 18 years or so after we discharge them, anyway.

  2. TheNewGuy says:

    Yep… the SQ air was pretty obvious on that one.

    My favorites are the ones that are large enough to lose a large pair of Kelley clamps… that and the anaerobes…

    The gram negatives and anaerobes come from addicts who reuse needles. When reusing their needles, they frequently lick (yes, with their tongue) the needle tip to make sure it’s still usable (ie. not barbed).

    Terrible disease, addiction.

  3. Stan Wells says:

    My practice is in ER and trauma radiology. The suffering these people have is incredible. While I am opposed to substance abuse I think it is time we consider a program that provides clean equipment and substances (which could be controlled and taxed) to relieve some of this type of suffering.

  4. Clean needle programs have been tried in many places, but I don’t know their results. I suspect the resulting data could be parsed any way the writer desired, but I’d be interested in hearing success stories.

  5. There are a couple of clean needle programs in cities in the UK.. and hospitals or surgeries/clinics will always take dirty ones and dispose of them safely. I believe that while they have little effect on rates of drug use (inasmuch as that data’s available) they’re pretty good at preventing things like that abcess. I mean, if there’s the opportunity of clean needles, people tend to take it.