An Unusual and Fatal Cause of Miliary Nodules on Chest Radiography

Abstract

Foreign body granulomatosis has many etiologies, including the injection of oral medications intravenously. The insoluble filler materials that are used in the medications can lodge in pulmonary arterioles and capillaries, which can trigger foreign body giant cell reaction, chronic inflammation, thrombosis, and fibrosis, resulting in pulmonary hypertension, progressive shortness of breath, and, potentially, fatal conditions. On imaging, this may present with multiple miliary mottling’s/nodules. The use of a bronchoscopy with biopsy can be an excellent way to establish a diagnosis in appropriate clinical settings. Here, we present a case of a 37-year-old old male found to have multiple miliary densities on imaging due to intravenous use of oral medication.

Fatal Excipients

“…Clinically, the patient can present with an acute intoxication as well as acute, subacute, or chronic signs and symptoms, such as sudden or unexpected death, cardiac arrest, pain, dyspnea, fever, pulmonary fibrosis, acute lung injury, thromboembolism, cor pulmonale, and pulmonary hypertension 1 . Case reports and autopsy studies detail a history of chronic disease and peripheral line insertions as findings in patients with ELD 16,22,23 . A standout finding in 2 of the cases presented herein could potentially provide a clue to the diagnosis with the correlation of chronic illness, and micronodularity on HRCT is upper extremity deep vein thrombosis.…”

“…1 Case reports and autopsy studies detail a history of chronic disease and peripheral line insertions as findings in patients with ELD. 16,22,23 A standout finding in 2 of the cases presented herein could potentially provide a clue to the diagnosis with the correlation of chronic illness, and micronodularity on HRCT is upper extremity deep vein thrombosis. In general, upper extremity deep vein thrombosis is uncommon and accounts for 5% to 10% of all deep vein thrombosis.…”