Pulmonary Complications from Cocaine and Cocaine-based Substances: Imaging Manifestations

Abstract

Cocaine is the illicit drug whose abuse most often results in cardiopulmonary symptoms and emergency treatment. Habitual smoking of alkaloidal cocaine ("freebase," "crack") has replaced nasal insufflation as the most common method of abuse. Smoking of cocaine exposes the lung directly to the volatilized drug as well as to the other combustion products of the smoked mixture, thereby increasing the risk of adverse pulmonary effects. A wide variety of pulmonary complications including interstitial pneumonitis, fibrosis, pulmonary hypertension, alveolar hemorrhage, asthma exacerbation, barotrauma, thermal airway injury, hilar lymphadenopathies, and bullous emphysema may be associated with the inhalation of crack cocaine or of associated substances such as talc, silica, and lactose. Cocaine abuse represents one of the most serious medical and social problems of our time. Radiologists should be familiar with the various pleuropulmonary complications associated with the abuse of illicit drugs in general and of cocaine in particular to ensure correct diagnosis and appropriate treatment planning in patients with respiratory manifestations associated with such abuse.

Reactive Oxygen Species/Hypoxia-Inducible Factor-1α/Platelet-Derived Growth Factor-BB Autocrine Loop Contributes to Cocaine-Mediated Alveolar Epithelial Barrier Damage

“…Disruption of the epithelial barrier has been shown to contribute to the development of various pulmonary complications, such as chronic obstructive pulmonary disease and acute lung injury (7,8). It has been well recognized that cocaine-related deaths in drug addicts correlates with increased pulmonary edema, likely due to epithelial barrier breach (9). In keeping with this observation, the focus of the current study was to examine whether exposure of alveolar epithelial cells in vitro to exogenous cocaine could lead to disruption of epithelial barrier integrity, leading, in turn, to pulmonary inflammation.…”

Fate of Systemically Administered Cocaine in Nonhuman Primates Treated with the dAd5GNE Anticocaine Vaccine

“…Enzymatic and nonenzymatic hydrolysis to benzoylecgonine accounts for an average of 45% of cocaine, while enzymatic hydrolysis to ecgonine methyl ester accounts for about 40% of cocaine metabolism, and microsomal oxidative metabolism of cocaine to norcocaine only accounts for a small percentage (1-3%) of the metabolized drug ( Jeffcoat et al, 1989;Benowitz, 1993;Gorelick, 1997;Scheidweiler et al, 2010;Yao et al, 2013). These cocaine metabolites and cocaine per se are potentially toxic to not only the CNS but also the heart, liver, and other organs (Kloss et al, 1983;Silva et al, 1991;Benowitz, 1993;Hollander, 1995;Restrepo et al, 2007). Therefore, vaccinemediated redistribution of administered cocaine and/or its metabolites represents a potential safety concern.…”

“…The heart is not the only organ sensitive to cocaine-induced a-adrenoreceptor activation and the release of catelcholamines, norepinephrine, and epinephrine (Virmani et al, 1988;Derlet and Albertson, 1989;Brody et al, 1990;Lipton et al, 2000). Cocaine-associated ischemic injury has also been documented in many peripheral organs, including the muscle, kidney, placenta, large intestine, and liver ( Muscholl, 1961;Benowitz, 1993;Gray, 1993;Lange and Hillis, 2001;Restrepo et al, 2007). dAd5GNE immunization reduced cocaine, benzoylecgoine, and ecgonine methyl ester distribution in the brain, adrenal glands, spleen, lung, heart, and kidney.…”

Image of the month: Chest pain after cocaine use

“…1 The majority of patients are young, male, smokers and have a previous history of cocaine abuse. 2 The differential diagnosis of cocaine-induced chest pain includes:…”

“…2 Pneumomediastinum is an uncommon complication of cocaine use and occurs more often when smoked rather than following nasal inhalation. 3 It has been hypothesised that the forceful snorting and Valsalva manoeuvre increase the pressure in the alveoli which can cause alveolar rupture and pneumomediastinum.…”