Conclusions:
This case illustrates the importance to include needle embolization to the heart as a potential differential diagnosis in a patient with past or current drug abuse presenting with angina or dyspnea. It also highlights the lack of guidelines and discusses key considerations in withholding treatment in asymptomatic patients, as well as treatment considerations in a symptomatic patient (e.g. possible cardiac tamponade, infections, embolisms, or arrhythmias) including sternotomy with exploration of the mediastinal cavity.