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Thoracic Complications of Illicit Drug Use: An Organ System Approach¹

¹ From the Departments of Radiology (M.B.G., S.R.M., S.K.D., A.D.G.) and Pathology (D.K.H.), San Francisco General Hospital, 1001 Potrero Ave, Rm 1X 55A, Box 1325, San Francisco, CA 94110; the Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Mass (J.W.T.L.); and the Department of Radiology, University of California, San Francisco (M.B.G., S.R.M., S.K.D., A.D.G., G.P.R., P.A.A., W.R.W.). Presented as an education exhibit at the 2001 RSNA scientific assembly. Received February 6, 2001; revision requested March 18 and received April 12; accepted April 18. Address correspondence to M.B.G. (e-mail: michael.gotway@radiology.ucsf.edu).

Illicit drug use constitutes a major health problem and may be associated with various thoracic complications. These complications vary depending on the specific drug used and the route of administration. Commonly abused drugs that may play a role in causing thoracic disease include cocaine, opiates, and methamphetamine derivatives. Intravenously abused oral medications may contain filler agents that may be responsible for disease. Thoracic complications may be categorized as pulmonary, pleural, mediastinal, cardiovascular, and chest wall complications. Pulmonary complications of drug abuse include pneumonia, cardiogenic edema, acute lung injury, pulmonary hemorrhage, and aspiration pneumonia. Filler agents such as talc may result in panacinar emphysema or high-attenuation upper-lobe conglomerate masses. The primary pleural complication of illicit drug use is pneumothorax. Mediastinal and cardiovascular complications of illicit drug use include pneumomediastinum, cardiomyopathy, myocardial infarction, aortic dissection, and injection-related pseudoaneurysms. Chest wall complications include diskitis and vertebral osteomyelitis, epidural abscess, necrotizing fasciitis, costochondritis, and septic arthritis. Categorization of thoracic complications of illicit drug use may facilitate understanding of these disorders and allow accurate diagnosis.

© RSNA, 2002

Index Terms: Drugs, abuse, 47.64, 50.64, 60.64 • Drugs, side effects, 47.64, 50.64, 60.64 • Lung, effects of drugs on, 60.21, 60.214, 60.64, 60.71, 60.751 • Mediastinum, diseases, 67.735 • Pericardium, abnormalities, 55.823 • Pleura, diseases, 66.73 • Talc • Thorax, CT, 60.1211 • Thorax, diseases, 47.21, 50.491, 50.761

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