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Radiology of Recreational Drug Abuse¹

¹ From the Departments of Radiology, Bristol Royal Infirmary (I.G.H.) and Southmead Hospital (K.B.), Bristol, England. Presented as an education exhibit at the 2005 RSNA Annual Meeting. Received May 18, 2006; revision requested August 22 and received October 30; accepted October 30. All authors have no financial relationships to disclose.

View larger version (171K): [in this window] [in a new window] [Download PPT slide]   Figure 1.  Acute anterior myocardial infarction after cocaine use in a 41-year-old man. Cranial right anterior oblique view from left coronary angiography shows an ill-defined filling defect (arrows) in the mid left anterior descending artery. The filling defect is due to a soft thrombus. The coronary vessels are otherwise normal.

 

View larger version (107K): [in this window] [in a new window] [Download PPT slide]   Figure 2a.  Cocaine-induced dilated cardiomyopathy in a 48-year-old man. (a) Contrast-enhanced computed tomographic (CT) image (window level = 40 HU, window width = 400 HU) shows dilatation of the left ventricle and a filling defect in the ventricle (arrow), which represents a mural thrombus. (b) CT image obtained 6 months later, after abstinence from cocaine and treatment with warfarin, shows that the heart is normal in size and no thrombus is seen.

 

View larger version (92K): [in this window] [in a new window] [Download PPT slide]   Figure 2b.  Cocaine-induced dilated cardiomyopathy in a 48-year-old man. (a) Contrast-enhanced computed tomographic (CT) image (window level = 40 HU, window width = 400 HU) shows dilatation of the left ventricle and a filling defect in the ventricle (arrow), which represents a mural thrombus. (b) CT image obtained 6 months later, after abstinence from cocaine and treatment with warfarin, shows that the heart is normal in size and no thrombus is seen.

 

View larger version (92K): [in this window] [in a new window] [Download PPT slide]   Figure 3a.  Endocarditis of the tricuspid valve in a 24-year-old male IV drug user. Parasternal short-axis views from echocardiography, obtained during systole (a) and diastole (b), show a mobile echogenic mass (arrow) related to the tricuspid valve, a finding consistent with a vegetation. Chest radiography showed multiple septic pulmonary emboli. LV = left ventricle, RA = right atrium, RV = right ventricle.

 

View larger version (103K): [in this window] [in a new window] [Download PPT slide]   Figure 3b.  Endocarditis of the tricuspid valve in a 24-year-old male IV drug user. Parasternal short-axis views from echocardiography, obtained during systole (a) and diastole (b), show a mobile echogenic mass (arrow) related to the tricuspid valve, a finding consistent with a vegetation. Chest radiography showed multiple septic pulmonary emboli. LV = left ventricle, RA = right atrium, RV = right ventricle.

 

View larger version (109K): [in this window] [in a new window] [Download PPT slide]   Figure 4.  False aneurysm in a 36-year-old female IV drug user. Transverse image from duplex US of the left groin shows a jet that communicates between the common femoral artery and an anterior cavity via a narrow neck.

 

View larger version (154K): [in this window] [in a new window] [Download PPT slide]   Figure 5a.  Renal mycotic aneurysm in a 33-year-old male IV drug user with endocarditis who presented with hematuria and clot retention. US showed an aneurysm in the upper pole of the right kidney. (a) Coronal reformatted image from contrast-enhanced CT (window level = 40 HU, window width = 500 HU) shows an intrarenal aneurysm (black arrows) arising from an upper pole renal artery (white arrows). No enhancement of the renal parenchyma is seen surrounding the aneurysm; there is low-attenuation material extending into the renal pelvis and upper ureter (arrowheads), a finding that represents blood. (b) Selective conventional arteriogram shows a jet of contrast material (arrow) entering the aneurysm. (c) Image obtained later in the angiographic series shows incomplete opacification of the aneurysm (arrowheads) due to the presence of thrombosis. The aneurysm was successfully treated with coil embolization followed by nephrectomy.

 

View larger version (133K): [in this window] [in a new window] [Download PPT slide]   Figure 5b.  Renal mycotic aneurysm in a 33-year-old male IV drug user with endocarditis who presented with hematuria and clot retention. US showed an aneurysm in the upper pole of the right kidney. (a) Coronal reformatted image from contrast-enhanced CT (window level = 40 HU, window width = 500 HU) shows an intrarenal aneurysm (black arrows) arising from an upper pole renal artery (white arrows). No enhancement of the renal parenchyma is seen surrounding the aneurysm; there is low-attenuation material extending into the renal pelvis and upper ureter (arrowheads), a finding that represents blood. (b) Selective conventional arteriogram shows a jet of contrast material (arrow) entering the aneurysm. (c) Image obtained later in the angiographic series shows incomplete opacification of the aneurysm (arrowheads) due to the presence of thrombosis. The aneurysm was successfully treated with coil embolization followed by nephrectomy.

 

View larger version (178K): [in this window] [in a new window] [Download PPT slide]   Figure 5c.  Renal mycotic aneurysm in a 33-year-old male IV drug user with endocarditis who presented with hematuria and clot retention. US showed an aneurysm in the upper pole of the right kidney. (a) Coronal reformatted image from contrast-enhanced CT (window level = 40 HU, window width = 500 HU) shows an intrarenal aneurysm (black arrows) arising from an upper pole renal artery (white arrows). No enhancement of the renal parenchyma is seen surrounding the aneurysm; there is low-attenuation material extending into the renal pelvis and upper ureter (arrowheads), a finding that represents blood. (b) Selective conventional arteriogram shows a jet of contrast material (arrow) entering the aneurysm. (c) Image obtained later in the angiographic series shows incomplete opacification of the aneurysm (arrowheads) due to the presence of thrombosis. The aneurysm was successfully treated with coil embolization followed by nephrectomy.

 

View larger version (162K): [in this window] [in a new window] [Download PPT slide]   Figure 6.  Chronic nonocclusive thrombus in a 28-year-old male IV drug user. Longitudinal US image of the common femoral vein shows the regular injection site, which is indicated by a hypoechoic scar extending from the skin to the vessel. A chronic nonocclusive thrombus (T) is seen in the vein with acquired venous stenosis.

 

View larger version (108K): [in this window] [in a new window] [Download PPT slide]   Figure 7.  Venous thrombosis in a 27-year-old female IV drug user. Longitudinal image from abdominal US shows thrombosis (arrows) extending up the inferior vena cava.

 

View larger version (128K): [in this window] [in a new window] [Download PPT slide]   Figure 8a.  Lipoid pneumonia in a 52-year-old man with a persistent area of consolidation in the right lower lobe that was unresponsive to antibiotics. After biopsy with inconclusive results, surgical resection revealed lipoid pneumonia, and the patient gave a history of accidental aspiration of "poppers" (amyl or butyl nitrite). (a) High-resolution CT image (window level = –500 HU, window width = 1500 HU) shows a rounded area of consolidation in the right lower lobe. (b) CT image shows thickened interlobular septa and subtle tree-in-bud abnormalities just below the area of consolidation; these are features of lipoid pneumonia.

 

View larger version (121K): [in this window] [in a new window] [Download PPT slide]   Figure 8b.  Lipoid pneumonia in a 52-year-old man with a persistent area of consolidation in the right lower lobe that was unresponsive to antibiotics. After biopsy with inconclusive results, surgical resection revealed lipoid pneumonia, and the patient gave a history of accidental aspiration of "poppers" (amyl or butyl nitrite). (a) High-resolution CT image (window level = –500 HU, window width = 1500 HU) shows a rounded area of consolidation in the right lower lobe. (b) CT image shows thickened interlobular septa and subtle tree-in-bud abnormalities just below the area of consolidation; these are features of lipoid pneumonia.

 

View larger version (156K): [in this window] [in a new window] [Download PPT slide]   Figure 9.  Acute noncardiogenic pulmonary edema in a 19-year-old man after an overdose of MDMA. Chest radiograph shows bilateral perihilar airspace shadowing with normal heart size and no pleural effusion.

 

View larger version (93K): [in this window] [in a new window] [Download PPT slide]   Figure 10a.  Acute pulmonary embolism in a 38-year-old male IV drug user. (a) Pulmonary CT angiogram (window level = 40 HU, window width = 400 HU) shows a filling defect in a right lower lobe pulmonary artery (arrow). (b) CT image shows a small area of pulmonary infarction just beyond the embolus.

 

View larger version (136K): [in this window] [in a new window] [Download PPT slide]   Figure 10b.  Acute pulmonary embolism in a 38-year-old male IV drug user. (a) Pulmonary CT angiogram (window level = 40 HU, window width = 400 HU) shows a filling defect in a right lower lobe pulmonary artery (arrow). (b) CT image shows a small area of pulmonary infarction just beyond the embolus.

 

View larger version (155K): [in this window] [in a new window] [Download PPT slide]   Figure 11a.  Septic pulmonary emboli in a 26-year-old male IV drug user. (a) Chest radiograph shows at least two pulmonary nodules (short arrows). A strong diagnostic clue is provided by the syringe (long arrows) in the patient’s shirt pocket. (b) Magnified view of the left lung base shows the syringe.

 

View larger version (138K): [in this window] [in a new window] [Download PPT slide]   Figure 11b.  Septic pulmonary emboli in a 26-year-old male IV drug user. (a) Chest radiograph shows at least two pulmonary nodules (short arrows). A strong diagnostic clue is provided by the syringe (long arrows) in the patient’s shirt pocket. (b) Magnified view of the left lung base shows the syringe.

 

View larger version (104K): [in this window] [in a new window] [Download PPT slide]   Figure 12a.  Pyopneumothorax complicating septic emboli in a 28-year-old male IV drug user. (a) Contrast-enhanced thoracic CT image (window level = –500 HU, window width = 1500 HU) shows cavitating lesions in the left upper lobe. (b) CT image obtained inferiorly to a shows right-sided pyopneumothorax due to rupture of a peripheral pulmonary abscess into the pleural space.

 

View larger version (106K): [in this window] [in a new window] [Download PPT slide]   Figure 12b.  Pyopneumothorax complicating septic emboli in a 28-year-old male IV drug user. (a) Contrast-enhanced thoracic CT image (window level = –500 HU, window width = 1500 HU) shows cavitating lesions in the left upper lobe. (b) CT image obtained inferiorly to a shows right-sided pyopneumothorax due to rupture of a peripheral pulmonary abscess into the pleural space.

 

View larger version (140K): [in this window] [in a new window] [Download PPT slide]   Figure 13a.  Bullous emphysema in a 27-year-old man with a long history of heavy marijuana use and only modest tobacco consumption. (a) Chest radiograph obtained at presentation shows a large left-sided pneumothorax. There are also bullae at the right apex. (b) High-resolution CT image (window level = –500 HU, window width = 1500 HU) obtained after reinflation of the left lung shows large bilateral apical bullae. The remainder of the lungs was normal. (c) Follow-up chest CT image obtained 4 years later after continued heavy marijuana use shows progression of the bullous lung disease.

 

View larger version (119K): [in this window] [in a new window] [Download PPT slide]   Figure 13b.  Bullous emphysema in a 27-year-old man with a long history of heavy marijuana use and only modest tobacco consumption. (a) Chest radiograph obtained at presentation shows a large left-sided pneumothorax. There are also bullae at the right apex. (b) High-resolution CT image (window level = –500 HU, window width = 1500 HU) obtained after reinflation of the left lung shows large bilateral apical bullae. The remainder of the lungs was normal. (c) Follow-up chest CT image obtained 4 years later after continued heavy marijuana use shows progression of the bullous lung disease.

 

View larger version (99K): [in this window] [in a new window] [Download PPT slide]   Figure 13c.  Bullous emphysema in a 27-year-old man with a long history of heavy marijuana use and only modest tobacco consumption. (a) Chest radiograph obtained at presentation shows a large left-sided pneumothorax. There are also bullae at the right apex. (b) High-resolution CT image (window level = –500 HU, window width = 1500 HU) obtained after reinflation of the left lung shows large bilateral apical bullae. The remainder of the lungs was normal. (c) Follow-up chest CT image obtained 4 years later after continued heavy marijuana use shows progression of the bullous lung disease.

 

View larger version (142K): [in this window] [in a new window] [Download PPT slide]   Figure 14.  Intracerebral hemorrhage related to cocaine use in a 40-year-old man. Unenhanced cranial CT image (window level = 40 HU, window width = 100 HU) shows acute hemorrhage in the left basal ganglia with intraventricular extension.

 

View larger version (153K): [in this window] [in a new window] [Download PPT slide]   Figure 15a.  Acute cerebral infarction after MDMA use in a 21-year-old woman. (a) Axial fluid-attenuated inversion-recovery MR image shows cortical and subcortical high signal intensity in the right frontal lobe. (b) Axial T2-weighted MR image shows fixed gaze deviation to the left. Gaze disorders are among the toxic effects of MDMA.

 

View larger version (144K): [in this window] [in a new window] [Download PPT slide]   Figure 15b.  Acute cerebral infarction after MDMA use in a 21-year-old woman. (a) Axial fluid-attenuated inversion-recovery MR image shows cortical and subcortical high signal intensity in the right frontal lobe. (b) Axial T2-weighted MR image shows fixed gaze deviation to the left. Gaze disorders are among the toxic effects of MDMA.

 

View larger version (78K): [in this window] [in a new window] [Download PPT slide]   Figure 16a.  PRES due to cocaine-induced malignant hypertension in a 23-year-old man with headaches, confusion, seizures, and very high blood pressure after cocaine use. (a) Unenhanced cranial CT image shows subtle cortical and subcortical low attenuation in the parieto-occipital region bilaterally. (b, c) Axial T2-weighted MR images show abnormal high signal intensity in the same location (b) and more inferiorly in the occipital lobes (c), findings typical of PRES. Owing to clinical symptoms of a spinal cord syndrome, images of the entire spine were obtained. (d) Sagittal T2-weighted MR image shows abnormal central high signal intensity throughout the spinal cord. This finding is highly unusual for PRES and raised concern about spinal infarction. However, the patient responded well to medical management of the hypertension. (e, f) Repeat axial (e) and sagittal (f) T2-weighted MR images obtained 4 weeks later show complete resolution of the radiologic abnormalities.

 

View larger version (154K): [in this window] [in a new window] [Download PPT slide]   Figure 16b.  PRES due to cocaine-induced malignant hypertension in a 23-year-old man with headaches, confusion, seizures, and very high blood pressure after cocaine use. (a) Unenhanced cranial CT image shows subtle cortical and subcortical low attenuation in the parieto-occipital region bilaterally. (b, c) Axial T2-weighted MR images show abnormal high signal intensity in the same location (b) and more inferiorly in the occipital lobes (c), findings typical of PRES. Owing to clinical symptoms of a spinal cord syndrome, images of the entire spine were obtained. (d) Sagittal T2-weighted MR image shows abnormal central high signal intensity throughout the spinal cord. This finding is highly unusual for PRES and raised concern about spinal infarction. However, the patient responded well to medical management of the hypertension. (e, f) Repeat axial (e) and sagittal (f) T2-weighted MR images obtained 4 weeks later show complete resolution of the radiologic abnormalities.

 

View larger version (157K): [in this window] [in a new window] [Download PPT slide]   Figure 16c.  PRES due to cocaine-induced malignant hypertension in a 23-year-old man with headaches, confusion, seizures, and very high blood pressure after cocaine use. (a) Unenhanced cranial CT image shows subtle cortical and subcortical low attenuation in the parieto-occipital region bilaterally. (b, c) Axial T2-weighted MR images show abnormal high signal intensity in the same location (b) and more inferiorly in the occipital lobes (c), findings typical of PRES. Owing to clinical symptoms of a spinal cord syndrome, images of the entire spine were obtained. (d) Sagittal T2-weighted MR image shows abnormal central high signal intensity throughout the spinal cord. This finding is highly unusual for PRES and raised concern about spinal infarction. However, the patient responded well to medical management of the hypertension. (e, f) Repeat axial (e) and sagittal (f) T2-weighted MR images obtained 4 weeks later show complete resolution of the radiologic abnormalities.

 

View larger version (148K): [in this window] [in a new window] [Download PPT slide]   Figure 16d.  PRES due to cocaine-induced malignant hypertension in a 23-year-old man with headaches, confusion, seizures, and very high blood pressure after cocaine use. (a) Unenhanced cranial CT image shows subtle cortical and subcortical low attenuation in the parieto-occipital region bilaterally. (b, c) Axial T2-weighted MR images show abnormal high signal intensity in the same location (b) and more inferiorly in the occipital lobes (c), findings typical of PRES. Owing to clinical symptoms of a spinal cord syndrome, images of the entire spine were obtained. (d) Sagittal T2-weighted MR image shows abnormal central high signal intensity throughout the spinal cord. This finding is highly unusual for PRES and raised concern about spinal infarction. However, the patient responded well to medical management of the hypertension. (e, f) Repeat axial (e) and sagittal (f) T2-weighted MR images obtained 4 weeks later show complete resolution of the radiologic abnormalities.

 

View larger version (126K): [in this window] [in a new window] [Download PPT slide]   Figure 16e.  PRES due to cocaine-induced malignant hypertension in a 23-year-old man with headaches, confusion, seizures, and very high blood pressure after cocaine use. (a) Unenhanced cranial CT image shows subtle cortical and subcortical low attenuation in the parieto-occipital region bilaterally. (b, c) Axial T2-weighted MR images show abnormal high signal intensity in the same location (b) and more inferiorly in the occipital lobes (c), findings typical of PRES. Owing to clinical symptoms of a spinal cord syndrome, images of the entire spine were obtained. (d) Sagittal T2-weighted MR image shows abnormal central high signal intensity throughout the spinal cord. This finding is highly unusual for PRES and raised concern about spinal infarction. However, the patient responded well to medical management of the hypertension. (e, f) Repeat axial (e) and sagittal (f) T2-weighted MR images obtained 4 weeks later show complete resolution of the radiologic abnormalities.

 

View larger version (157K): [in this window] [in a new window] [Download PPT slide]   Figure 16f.  PRES due to cocaine-induced malignant hypertension in a 23-year-old man with headaches, confusion, seizures, and very high blood pressure after cocaine use. (a) Unenhanced cranial CT image shows subtle cortical and subcortical low attenuation in the parieto-occipital region bilaterally. (b, c) Axial T2-weighted MR images show abnormal high signal intensity in the same location (b) and more inferiorly in the occipital lobes (c), findings typical of PRES. Owing to clinical symptoms of a spinal cord syndrome, images of the entire spine were obtained. (d) Sagittal T2-weighted MR image shows abnormal central high signal intensity throughout the spinal cord. This finding is highly unusual for PRES and raised concern about spinal infarction. However, the patient responded well to medical management of the hypertension. (e, f) Repeat axial (e) and sagittal (f) T2-weighted MR images obtained 4 weeks later show complete resolution of the radiologic abnormalities.

 

View larger version (120K): [in this window] [in a new window] [Download PPT slide]   Figure 17.  Cerebral abscess in a 25-year-old male IV drug user. Contrast-enhanced cranial CT image (window level = 40 HU, window width = 100 HU) shows a small enhancing lesion in the left caudate nucleus (arrow).

 

View larger version (112K): [in this window] [in a new window] [Download PPT slide]   Figure 18a.  Iliopsoas abscess in a 30-year-old male IV drug user. (a) Axial contrast-enhanced abdominal CT image (window level = 40 HU, window width = 400 HU) shows an abscess in the right groin, within which a needle fragment (arrow) is visible. Note the flexed hip position adopted by the patient. (b) Sagittal oblique reformatted image from the same study shows the superior extent of the iliopsoas abscess (arrows). The needle fragment is seen inferiorly.

 

View larger version (144K): [in this window] [in a new window] [Download PPT slide]   Figure 18b.  Iliopsoas abscess in a 30-year-old male IV drug user. (a) Axial contrast-enhanced abdominal CT image (window level = 40 HU, window width = 400 HU) shows an abscess in the right groin, within which a needle fragment (arrow) is visible. Note the flexed hip position adopted by the patient. (b) Sagittal oblique reformatted image from the same study shows the superior extent of the iliopsoas abscess (arrows). The needle fragment is seen inferiorly.

 

View larger version (121K): [in this window] [in a new window] [Download PPT slide]   Figure 19a.  Septic arthritis as a complication of IV drug abuse in two patients. (a) Axial unenhanced CT image (window level = 400 HU, window width = 1500 HU) of a 34-year-old man shows sclerosis and erosions at the right sacroiliac joint due to septic arthritis. (b) Coronal short inversion time inversion-recovery MR image of a 36-year-old man shows destruction of the right femoral head and acetabulum, a joint effusion, and extensive abnormal high signal intensity in adjacent soft tissues due to septic arthritis of the hip joint.

 

View larger version (144K): [in this window] [in a new window] [Download PPT slide]   Figure 19b.  Septic arthritis as a complication of IV drug abuse in two patients. (a) Axial unenhanced CT image (window level = 400 HU, window width = 1500 HU) of a 34-year-old man shows sclerosis and erosions at the right sacroiliac joint due to septic arthritis. (b) Coronal short inversion time inversion-recovery MR image of a 36-year-old man shows destruction of the right femoral head and acetabulum, a joint effusion, and extensive abnormal high signal intensity in adjacent soft tissues due to septic arthritis of the hip joint.

 

View larger version (106K): [in this window] [in a new window] [Download PPT slide]   Figure 20a.  Septic arthritis in a 29-year-old IV drug user. Pulmonary CT angiography showed multiple septic emboli. (a) Axial CT image (window level = 150 HU, window width = 600 HU) shows soft-tissue swelling over the right sternoclavicular joint (arrows) with poor definition of the medial clavicle. (b) Oblique axial reformatted image (window level = 500 HU, window width = 2400 HU) of the right sternoclavicular joint shows erosive changes on either side of the joint, a finding consistent with septic arthritis.

 

View larger version (96K): [in this window] [in a new window] [Download PPT slide]   Figure 20b.  Septic arthritis in a 29-year-old IV drug user. Pulmonary CT angiography showed multiple septic emboli. (a) Axial CT image (window level = 150 HU, window width = 600 HU) shows soft-tissue swelling over the right sternoclavicular joint (arrows) with poor definition of the medial clavicle. (b) Oblique axial reformatted image (window level = 500 HU, window width = 2400 HU) of the right sternoclavicular joint shows erosive changes on either side of the joint, a finding consistent with septic arthritis.

 

View larger version (95K): [in this window] [in a new window] [Download PPT slide]   Figure 21a.  Clinically unsuspected multifocal septic arthritis in a 28-year-old male IV drug user. The patient presented with chest pain, and pulmonary CT angiography showed septic pulmonary emboli. (a) CT image obtained with a bone window (level = 400 HU, width = 2000 HU) shows destructive changes at the manubriosternal joint (arrows) with soft-tissue swelling, findings strongly suggestive of septic arthritis. (b) Anterior (ANT) and posterior (POST) images from subsequent whole-body bone scintigraphy show increased uptake at the manubriosternal joint, as well as increased activity at the right wrist and left third metacarpophalangeal joint, both of which proved to be additional foci of septic arthritis.

 

View larger version (136K): [in this window] [in a new window] [Download PPT slide]   Figure 21b.  Clinically unsuspected multifocal septic arthritis in a 28-year-old male IV drug user. The patient presented with chest pain, and pulmonary CT angiography showed septic pulmonary emboli. (a) CT image obtained with a bone window (level = 400 HU, width = 2000 HU) shows destructive changes at the manubriosternal joint (arrows) with soft-tissue swelling, findings strongly suggestive of septic arthritis. (b) Anterior (ANT) and posterior (POST) images from subsequent whole-body bone scintigraphy show increased uptake at the manubriosternal joint, as well as increased activity at the right wrist and left third metacarpophalangeal joint, both of which proved to be additional foci of septic arthritis.

 

View larger version (84K): [in this window] [in a new window] [Download PPT slide]   Figure 22a.  Infective diskitis in a 43-year-old male IV drug user. Sagittal T2-weighted (a) and gadolinium-enhanced T1-weighted (b) MR images of the thoracolumbar spine show typical changes of diskitis at T11-12 with abnormal signal intensity and destruction of the intervertebral disk and adjacent vertebral end-plates. Enhancing inflammatory tissue bulges the anterior and posterior longitudinal ligaments, and there is associated compression of the spinal cord.

 

View larger version (86K): [in this window] [in a new window] [Download PPT slide]   Figure 22b.  Infective diskitis in a 43-year-old male IV drug user. Sagittal T2-weighted (a) and gadolinium-enhanced T1-weighted (b) MR images of the thoracolumbar spine show typical changes of diskitis at T11-12 with abnormal signal intensity and destruction of the intervertebral disk and adjacent vertebral end-plates. Enhancing inflammatory tissue bulges the anterior and posterior longitudinal ligaments, and there is associated compression of the spinal cord.

 

View larger version (154K): [in this window] [in a new window] [Download PPT slide]   Figure 23.  Oblique radiograph of the left hip in a 27-year-old male IV drug user shows two needles in the groin (arrows).

 

View larger version (159K): [in this window] [in a new window] [Download PPT slide]   Figure 24.  Cirrhosis due to chronic hepatitis C infection acquired as a result of IV drug use in a 44-year-old man. Contrast-enhanced CT image (window level = 40 HU, window width = 340 HU) shows that the right lobe of the liver has a slightly irregular margin. Recanalization of the umbilical vein (arrowhead), collateral veins in the abdominal wall (arrows), and splenomegaly reflect portal hypertension.

 

View larger version (136K): [in this window] [in a new window] [Download PPT slide]   Figure 25.  Hypercalcemia in a 30-year-old man with a long history of IV drug use. The hypercalcemia was subsequently found to be due to tertiary hyperparathyroidism complicating end-stage renal failure secondary to drug abuse. Bone scintigrams show striking gastric and pulmonary uptake; both findings are recognized features of hyperparathyroidism.

 

View larger version (144K): [in this window] [in a new window] [Download PPT slide]   Figure 26.  Cecal infarction in a 32-year-old man with acute abdominal pain and a history of cocaine abuse. Contrast-enhanced CT image of the abdomen shows mixed-attenuation mural thickening of the cecum with stranding in pericecal fat and extraluminal gas. Cecal infarction was confirmed at laparotomy. (Courtesy of Bettina Siewert, MD, Beth Israel Deaconess Medical Center, Boston, Mass.)

 

View larger version (114K): [in this window] [in a new window] [Download PPT slide]   Figure 27a.  Incidentally found drug packet in a 37-year-old man who had recently arrived from Jamaica and was stabbed in the left loin during an argument. (a) Contrast-enhanced CT image of the abdomen (window level = 40 HU, window width = 400 HU) shows the knife track with air in the left paraspinal muscles and retroperitoneum (arrowheads) but no serious visceral injury. (b) CT image shows a high-attenuation tubular structure (arrow) at the rectosigmoid junction. The tubular structure proved to be a drug packet.

 

View larger version (140K): [in this window] [in a new window] [Download PPT slide]   Figure 27b.  Incidentally found drug packet in a 37-year-old man who had recently arrived from Jamaica and was stabbed in the left loin during an argument. (a) Contrast-enhanced CT image of the abdomen (window level = 40 HU, window width = 400 HU) shows the knife track with air in the left paraspinal muscles and retroperitoneum (arrowheads) but no serious visceral injury. (b) CT image shows a high-attenuation tubular structure (arrow) at the rectosigmoid junction. The tubular structure proved to be a drug packet.

 

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