Cocaine-induced pulmonary changes: HRCT findings

Abstract

Objective: To evaluate HRCT scans of the chest in 22 patients with cocaine-induced pulmonary disease. Methods: We included patients between 19 and 52 years of age. The HRCT scans were evaluated by two radiologists independently, discordant results being resolved by consensus. The inclusion criterion was an HRCT scan showing abnormalities that were temporally related to cocaine use, with no other apparent causal factors. Results: In 8 patients (36.4%), the clinical and tomographic findings were consistent with "crack lung", those cases being studied separately. The major HRCT findings in that subgroup of patients included ground-glass opacities, in 100% of the cases; consolidations, in 50%; and the halo sign, in 25%. In 12.5% of the cases, smooth septal thickening, paraseptal emphysema, centrilobular nodules, and the tree-in-bud pattern were identified. Among the remaining 14 patients (63.6%), barotrauma was identified in 3 cases, presenting as pneumomediastinum, pneumothorax, and hemopneumothorax, respectively. Talcosis, characterized as perihilar conglomerate masses, architectural distortion, and emphysema, was diagnosed in 3 patients. Other patterns were found less frequently: organizing pneumonia and bullous emphysema, in 2 patients each; and pulmonary infarction, septic embolism, eosinophilic pneumonia, and cardiogenic pulmonary edema, in 1 patient each. Conclusions: Pulmonary changes induced by cocaine use are varied and nonspecific. The diagnostic suspicion of cocaine-induced pulmonary disease depends, in most of the cases, on a careful drawing of correlations between clinical and radiological findings.

Pulmonary foreign body granulomatosis in a chronic user of powder cocaine

“…Clinical presentation and radiological findings are varied and highly nonspecific. 4 PFBG is a rare condition, and its true incidence is unknown. It is commonly encountered secondary to intravenous injection of pulverized pharmaceutical tablets containing insoluble binders, such as talc, cellulose, starch, and other street adulterants.…”

HRCT Patterns of Drug-Induced Interstitial Lung Diseases: A Review

“…It is a widely abused substance, because of its strong sympathomimetic and central nervous system stimulant effects, which are due to its capacity to interfere with the reuptake of catecholamines and serotonin. HRCT patterns associated with cocaine toxicity include GGO (reported in 100% of the cases) ( Figure 9); consolidations (50%); the halo sign (25%); as well as smooth septal thickening, paraseptal emphysema, centrilobular nodules, and the tree-in-bud pattern ( Figure 10) [48]; however, as many cocaine abusers are also marijuana or tobacco smokers, it is difficult to determine which alterations are specifically caused by cocaine [49]. Alterations provoked by cocaine can be divided in acute or chronic.…”

Pneumomediastinum in a smoking free-base cocaine abuser during sexual intercourse

“…Postero-anterior and lateral CXR and CT have definitely ruled out alternative causes of PM such as thoracic trauma, oesophageal rupture, and pulmonary infection. CXR and CT are important tools to investigate PM due to tracheobronchial tree laceration [10]. The analysis of cases of 104 patients affected by spontaneous PM showed that the main predisposing factors are young age, male sex, age less than 30 years, asthma, chronic bronchitis, and drug use [11].…”