Pulmonary Talcosis: Imaging Findings

Abstract

Talc is a mineral widely used in the ceramic, paper, plastics, rubber, paint, and cosmetic industries. Four distinct forms of pulmonary disease caused by talc have been defined. Three of them (talcosilicosis, talcoasbestosis, and pure talcosis) are associated with aspiration and differ in the composition of the inhaled substance. The fourth form, a result of intravenous administration of talc, is seen in drug users who inject medications intended for oral use. The disease most commonly affects men, with a mean age in the fourth decade of life. Presentation of patients with talc granulomatosis can range from asymptomatic to fulminant disease. Symptomatic patients typically present with nonspecific complaints, including progressive exertional dyspnea, and cough. Late complications include chronic respiratory failure, emphysema, pulmonary arterial hypertension, and cor pulmonale. History of occupational exposure or of drug addiction is the major clue to the diagnosis. The high-resolution computed tomography (HRCT) finding of small centrilobular nodules associated with heterogeneous conglomerate masses containing high-density amorphous areas, with or without panlobular emphysema in the lower lobes, is highly suggestive of pulmonary talcosis. The characteristic histopathologic feature in talc pneumoconiosis is the striking appearance of birefringent, needle-shaped particles of talc seen within the giant cells and in the areas of pulmonary fibrosis with the use of polarized light. In conclusion, computed tomography can play an important role in the diagnosis of pulmonary talcosis, since suggestive patterns may be observed. The presence of these patterns in drug abusers or in patients with an occupational history of exposure to talc is highly suggestive of pulmonary talcosis.

Pulmonary Talcosis With Intravenous Drug Abuse

“…These granulomas have giant cells that can be visualized as birefringent talc crystals with polarized light. 9 The perivascular distribution of talc granulomas is a distinct finding of intravenous drug abuse, unlike inhaled talc, where the deposition is predominantly around respiratory bronchioles and alveolar ducts. Larger talc crystals are also suggestive of intravenous drug abuse.…”

Routes of abuse of prescription opioid analgesics: a review and assessment of the potential impact of abuse-deterrent formulations

“…[78] Serious cutaneous complications have also been reported in individuals who crush and inject buprenorphine tablets; such complications appear to be at least in part due to the presence of silica in generic formulations. [79,80] Intravenous injection of opioid formulations not intended for parenteral use has also been associated with pulmonary complications [81,82] and endocarditis. [83,84] Costs associated with acute bacterial infections such as endocarditis, cellulitis, osteomyelitis and sepsis in individuals who abuse via injection have been shown to be substantial.…”

Illicit narcotic injection masquerading as acute pulmonary embolism

“…It is not typically on the initial differential diagnosis, unless the patient's history indicates IV drug abuse. 3,6 As is the circumstance in the current case, oftentimes patients do not divulge a history of substance abuse even when questioned. The diagnosis of foreign body granulomatosis is often made after other common conditions have been excluded.…”

“…[1][2][3][4][5][6][7] Oral medications such as pentazocine, codeine, hydrocodone, and temazepam contain insoluble fillers such as talc, cellulose, and starch. These fillers are designed to bind tablet particles together as well as prevent the tablet from sticking to machinery during the manufacturing process.…”

“…These fillers are designed to bind tablet particles together as well as prevent the tablet from sticking to machinery during the manufacturing process. [1][2][3] Oxymorphone hydrochloride is a film-coated extended-release tablet that contains silicified microcrystalline cellulose. 8 Microcrystalline cellulose when crushed and injected forms long rod-like crystals in pulmonary arteries and causes granuloma formation.…”