High-Resolution Computed Tomographic Findings of Cocaine-Induced Pulmonary Disease: A State of the Art Review

Abstract

Cocaine is the most commonly used illicit drug among patients presenting at hospital emergency departments and the most frequent cause of drug-related deaths reported by medical examiners. Various respiratory problems temporally associated with cocaine use have been reported. Acute and chronic uses also are responsible for lung complications, such as pulmonary edema, alveolar hemorrhage, pulmonary hypertension, organizing pneumonia, emphysema, barotrauma, infection, cancer, eosinophilic disease, and aspiration pneumonia. Although most imaging findings are nonspecific, they may raise suspicion of a cocaine-related etiology when considered together with patients' profiles and medical histories. This literature review describes cocaine-induced diseases with pulmonary involvement, with an emphasis on high-resolution chest computed tomographic findings and patterns.

A good night for a bad day

“…Respiratory bronchiolitis-associated interstitial lung disease, a smoke related lung disease, could be discussed but the most common CT findings associate centrilobular nodules to GGO and our patient had given up smoking several years ago 1. Eosinophilic lung diseases also need to be discussed 2. Predominant patterns on CT of acute eosinophilic pneumonia are bilateral patchy areas of GGO but frequently associated with interlobular septal thickening and consolidation.…”

Qual o seu diagnóstico?

“…Barotrauma is another complication resulting from the habit of smoking crack or inhaling cocaine (45,46) . Such a condition may manifest as pneumothorax, pneumomediastinum, pneumopericardium or subcutaneous emphysema (45,47) .…”

“…Such a condition may manifest as pneumothorax, pneumomediastinum, pneumopericardium or subcutaneous emphysema (45,47) . In cocaine users, increased intrathoracic pressure may be observed during the smoking act due to vigorous coughing or intentional production of a Valsalva maneuver to increase the drug absorption and maximize its effects (46) .…”

“…In cocaine users, increased intrathoracic pressure may be observed during the smoking act due to vigorous coughing or intentional production of a Valsalva maneuver to increase the drug absorption and maximize its effects (46) . Overdistention of the alveoli may cause their rupture and escape of air into the interstitium and, eventually, to the mediastinum, producing pneumomediastinum (45,48) . Vigorous aspiration following cocaine inhalation may cause pneumomediastinum by a similar mechanism (46,49) .…”

“…Barotrauma is generally diagnosed by chest radiography, but CT may be useful in the diagnosis in cases where radiography is not conclusive. In young individuals, the presence of air in the mediastinum should raise the suspicion of cocaine use in the absence of other etiological factors (45) .…”