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(Circulation. 1995;91:3020-3021.)
© 1995 American Heart Association, Inc.

Articles

Metallic Mercury Embolism

Herbert L. Fred, MD; David Marcus, MD

From the Department of Internal Medicine, the University of Texas Health Science Center at Houston, and the Department of Radiology, Baptist Hospital, Pensacola, Fla.

Correspondence to Dr Herbert L. Fred, 7600 Fannin, Houston, TX 77054.

	Introduction

Top Introduction

 
Venous embolization of metallic mercury is rare. It results from the accidental or deliberate injection of mercury into a peripheral vein. In most cases, the clinical manifestations, if any, are mild and of short duration; supportive care suffices; and prognosis is good.

Findings on chest radiograph are striking and should immediately suggest the diagnosis. One or both lungs invariably contain multiple, tiny, dense spherules diffusely distributed or confined primarily to dependent areas. These spherules sometimes appear as beaded chains filling pulmonary arterioles, giving an "angiogram effect." Occasionally, mercury can be seen in the heart, especially in the right ventricle where it tends to pool.

Because mercury can pass through the pulmonary capillary bed or around it via shunts, mercury emboli may be visible in radiographs of the head, neck, abdomen, or pelvis. The presence of metallic densities in these sites or in the heart, coupled with the aforementioned pulmonary abnormalities, differentiates mercury embolism from all other diagnostic considerations, particularly aspiration of mercury. We present here three cases that illustrate different degrees of metallic mercury embolism.

View larger version (98K): [in this window] [in a new window]   Figure 1. Case 1: Chest radiographs showing multiple metallic densities in both lungs, especially the left. Nine months earlier, this patient had attempted suicide by injecting himself with mercury intravenously.

View larger version (136K): [in this window] [in a new window]   Figure 2. Case 2: Chest radiograph showing tiny metallic densities in the lungs. Similar densities were evident in the liver, pelvis, and brain. Mercury had accidentally entered this patient's vein during blood sampling with a mercury-sealed syringe.

View larger version (113K): [in this window] [in a new window]   Figure 3. Case 3: Chest radiographs showing arborizing pulmonary arterioles filled with mercury. Note the pool of mercury in the apex of the right ventricle (arrows) and the metallic densities in the upper abdomen and paravertebral plexus. This patient, a schizophrenic, had injected mercury into the forearm.

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