DOI: 10.1148/rg.274065144
Pulmonary Complications from Cocaine and Cocaine-based Substances: Imaging Manifestations1
Carlos S. Restrepo, MD,
Jorge A. Carrillo, MD,
Santiago Martínez, MD,
Paulina Ojeda, MD,
Aura L. Rivera, MD, and
Ami Hatta, MD
1 From the Department of Radiology, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Dr, MC 7800, San Antonio, TX 78229 (C.S.R.); Department of Radiology, Hospital de Santa Clara, Bogota, Colombia (J.A.C., P.O., A.L.R.); Department of Radiology, Duke University Medical Center, Durham, NC (S.M.); and Department of Radiology, Louisiana State University Health Sciences Center, New Orleans, La (A.H.). Presented as an education exhibit at the 2005 RSNA Annual Meeting. Received July 28, 2006; revision requested August 15 and received October 20; accepted October 26. All authors have no financial relationships to disclose.
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Figure 1. Photograph illustrates the E coca plant, a shrub that is native to South America and grows in a variety of areas, including Venezuela, Colombia, Ecuador, Peru, Bolivia, Brazil, and northern Argentina.
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Figure 2a. Acute chest syndrome in a 49-year-old man who presented with progressive shortness of breath and fever after an intravenous cocaine binge. (a) Chest radiograph shows abnormal bilateral parenchymal opacities, which are more confluent in the right midlung zone. (b) High-resolution computed tomographic (CT) scan demonstrates diffuse bilateral reticular opacities with superimposed thickening of inter- and intralobular interstitium ("crazy paving pattern").
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Figure 2b. Acute chest syndrome in a 49-year-old man who presented with progressive shortness of breath and fever after an intravenous cocaine binge. (a) Chest radiograph shows abnormal bilateral parenchymal opacities, which are more confluent in the right midlung zone. (b) High-resolution computed tomographic (CT) scan demonstrates diffuse bilateral reticular opacities with superimposed thickening of inter- and intralobular interstitium ("crazy paving pattern").
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Figure 3a. Pneumomediastinum in a 28-year-old patient who presented with retrosternal chest pain after smoking crack cocaine. Posteroanterior (a) and lateral (b) chest radiographs show a lucent line extending into the anterior mediastinum (arrows).
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Figure 3b. Pneumomediastinum in a 28-year-old patient who presented with retrosternal chest pain after smoking crack cocaine. Posteroanterior (a) and lateral (b) chest radiographs show a lucent line extending into the anterior mediastinum (arrows).
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Figure 4. Spontaneous left-sided pneumothorax in a 33-year-old man who had been smoking crack cocaine. The patient presented with chest pain and had no history of trauma. Chest radiograph demonstrates hyperlucency of the left hemithorax and clearly depicts the visceral pleural line (arrows).
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Figure 5a. Crack cocaine–induced asthma in a 38-year-old woman. (a) Chest radiograph depicts ill-defined peribronchial and parahilar opacities. (b, c) CT scans of the anterior segment of the left upper lobe (b) and of both lower lobes (c) show scattered ground-glass opacities.
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Figure 5b. Crack cocaine–induced asthma in a 38-year-old woman. (a) Chest radiograph depicts ill-defined peribronchial and parahilar opacities. (b, c) CT scans of the anterior segment of the left upper lobe (b) and of both lower lobes (c) show scattered ground-glass opacities.
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Figure 5c. Crack cocaine–induced asthma in a 38-year-old woman. (a) Chest radiograph depicts ill-defined peribronchial and parahilar opacities. (b, c) CT scans of the anterior segment of the left upper lobe (b) and of both lower lobes (c) show scattered ground-glass opacities.
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Figure 6. Cardiogenic pulmonary edema in a 36-year-old woman who presented with shortness of breath and chest pain after smoking crack cocaine. Initial chest radiograph shows extensive bilateral heterogeneous central and parahilar opacities.
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Figure 8a. Pulmonary eosinophilia in a patient with a history of cocaine abuse. (a) Chest radiograph demonstrates bilateral parenchymal opacities with a predominantly peripheral distribution. (b) CT scan exhibits extensive bilateral disease with ground-glass opacities and airspace consolidation.
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Figure 8b. Pulmonary eosinophilia in a patient with a history of cocaine abuse. (a) Chest radiograph demonstrates bilateral parenchymal opacities with a predominantly peripheral distribution. (b) CT scan exhibits extensive bilateral disease with ground-glass opacities and airspace consolidation.
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Figure 9a. Pulmonary fibrosis in a 38-year-old woman with a long-term history of crack cocaine smoking. (a) Chest CT scan demonstrates bilateral, predominantly anterior reticular opacities and honeycombing. (b) On a CT scan obtained inferior to a, the opacities have a predominantly ground-glass appearance.
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Figure 9b. Pulmonary fibrosis in a 38-year-old woman with a long-term history of crack cocaine smoking. (a) Chest CT scan demonstrates bilateral, predominantly anterior reticular opacities and honeycombing. (b) On a CT scan obtained inferior to a, the opacities have a predominantly ground-glass appearance.
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Figure 10a. Talc granulomatosis in a patient with a history of intravenous cocaine abuse. (a) Chest radiograph demonstrates fine nodular opacities and areas of coalescence. (b) CT scan shows tiny diffuse nodules and peribronchovascular conglomerate masses (M) in both lungs.
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Figure 10b. Talc granulomatosis in a patient with a history of intravenous cocaine abuse. (a) Chest radiograph demonstrates fine nodular opacities and areas of coalescence. (b) CT scan shows tiny diffuse nodules and peribronchovascular conglomerate masses (M) in both lungs.
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Figure 11a. Talc granulomatosis in a long-term intravenous cocaine abuser. (a) High-resolution chest CT scan (lung windowing) demonstrates peribronchial thickening and numerous bilateral small basilar nodules. (b) High-resolution chest CT scan (soft-tissue windowing) shows the nodules with high attenuation.
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Figure 11b. Talc granulomatosis in a long-term intravenous cocaine abuser. (a) High-resolution chest CT scan (lung windowing) demonstrates peribronchial thickening and numerous bilateral small basilar nodules. (b) High-resolution chest CT scan (soft-tissue windowing) shows the nodules with high attenuation.
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Figure 12a. Silicotuberculosis in a crack cocaine smoker. (a) Chest radiograph shows bilateral, relatively symmetric parahilar masses (arrows). (b) CT scan better characterizes the masses.
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Figure 12b. Silicotuberculosis in a crack cocaine smoker. (a) Chest radiograph shows bilateral, relatively symmetric parahilar masses (arrows). (b) CT scan better characterizes the masses.
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Figure 13a. Silicosis in a crack cocaine smoker. (a) Chest radiograph shows diffuse bilateral reticulonodular opacities. (b) CT scan demonstrates small centrilobular nodules and ground-glass opacities. (c) Polarized light microscopic image shows evidence of birefringent particles (pink dots), a finding that represents free silica.
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Figure 13b. Silicosis in a crack cocaine smoker. (a) Chest radiograph shows diffuse bilateral reticulonodular opacities. (b) CT scan demonstrates small centrilobular nodules and ground-glass opacities. (c) Polarized light microscopic image shows evidence of birefringent particles (pink dots), a finding that represents free silica.
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Figure 13c. Silicosis in a crack cocaine smoker. (a) Chest radiograph shows diffuse bilateral reticulonodular opacities. (b) CT scan demonstrates small centrilobular nodules and ground-glass opacities. (c) Polarized light microscopic image shows evidence of birefringent particles (pink dots), a finding that represents free silica.
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Figure 14a. Severe pulmonary hypertension in a 43-year-old man with a history of cocaine abuse. (a) Chest radiograph exhibits prominence of the pulmonary arteries. (b) Contrast material–enhanced chest CT scan demonstrates dilatation of the main pulmonary arteries.
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Figure 14b. Severe pulmonary hypertension in a 43-year-old man with a history of cocaine abuse. (a) Chest radiograph exhibits prominence of the pulmonary arteries. (b) Contrast material–enhanced chest CT scan demonstrates dilatation of the main pulmonary arteries.
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Figure 15a. Advanced emphysema in a relatively young (36-year-old) woman with a history of heavy cocaine abuse and unrelated mitral valve disease. (a) Chest radiograph demonstrates hyperinflation of the lungs and signs of pulmonary hypertension. Note the predominance of hyperlucency in the upper lung regions, a finding that suggests a more severe upper lobe disease. (b) Chest CT scan reveals diffuse advanced emphysema.
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Figure 15b. Advanced emphysema in a relatively young (36-year-old) woman with a history of heavy cocaine abuse and unrelated mitral valve disease. (a) Chest radiograph demonstrates hyperinflation of the lungs and signs of pulmonary hypertension. Note the predominance of hyperlucency in the upper lung regions, a finding that suggests a more severe upper lobe disease. (b) Chest CT scan reveals diffuse advanced emphysema.
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Figure 16. Pneumonia in a cocaine abuser who presented with chest pain, cough, and fever. Chest CT scan demonstrates heterogeneous opacities in the left lower lobe. Posttreatment follow-up CT demonstrated resolution of these opacities.
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Figure 17. Non–small cell lung cancer in a patient with a 20-year history of crack cocaine abuse. CT scan shows a large, heterogeneous subcarinal and retrocardiac mass with enlarged hilar lymph nodes (arrows).
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Copyright © 2007 by the Radiological Society of North America.
