Learning objectives
1.
Define the spectrum of thoracic complications resulting from recreational and illicit drug use
2.
Illustrate the radiographic and CT findings related to recreational and illicit drug use
3.
Identify clues that can alert the radiologist to the possibility of illicit drug related complication
Background
Illicit drug use remains a global public health concern not only because of transmitted infections such as HIV and hepatitis viruses but also because of direct and indirect organ toxicity. It is estimated that approximately 5% of the world's population engages in illicit drug use and up 250,000 deaths per year result from this activity.
Illicit drug use can injure the cardiopulmonary system through systemic and inhalational routes,
and the injuries may be acute or develop slowly. Acute respiratory decompensation,
aspiration,
and pulmonary edema account...
Findings and procedure details
Aspiration
Aspiration is the most common lung injury resulting from illicit drug use and usually is related to sedative abuse,
particularly opiates. The risk of aspiration depends on the degree of central nervous system depression and the resultant impairment of normal protective mechanisms. The extent of injury depends on the content and volume of aspirate. Aspiration my clear spontaneously or can progress to infectious pneumonia,
lung abscess,
and empyema. Sepsis and acute respiratory distress syndrome can ensue and are associated with high mortality.
Key imaging...
Conclusion
With ongoing illicit drug use and increasing recreational drug use,
radiologists will likely encounter more cases ofcardiopulmonaryinjury resulting from their use. Awareness of the spectrum of cardiopulmonary complications is important for improving interpretation of diagnostic imaging tests.
Importantly,
it may be the radioloigist who brings up the potential of illicit or recreational drug abuse as the underlying cause of the patient's acute or chronic cardiopulmonary disease.
Personal information
Contact details:
Chest Radiologists Collaborative
Twitter: @chestradcollab
Corresponding author:
Jeffrey P.
Kanne,
M.D.
Professor and Chief of Thoracic Imaging
Department of Radiology
University of Wisconsin School of Medicine and Public Health
Madison,
WI USA
E-mail:
[email protected]
Twitter: @JeffreyKanneMD
jkrads.net
Coauthors:
Travis Henry,
M.D.
Associate Professor,
Cardiothoracic Imaging
Department of Radiology
University of California San Francisco
San Francisco,
CA USA
Twitter: @i_hate_nodules
thrads.com
Howard Mann,
M.D.
Professor,
Thoracic Imaging
Department of Radiology
University of Utah
Salt Lake City,
UT USA
Twitter: @howardm19
Seth Kligerman,
M.D.
Associate...
References
Berkowitz EA,
Henry TS,
Veeraraghavan S,
Staton GW Jr,
Gal AA.
Pulmonary
effects of synthetic marijuana: chest radiography and CT findings.
AJR Am J
Roentgenol. 2015 Apr;204(4):750-7
Gotway MB,
Marder SR,
Hanks DK,
Leung JW,
Dawn SK,
Gean AD,
Reddy GP,
AraozPA,
Webb WR.
Thoracic complications of illicit drug use: an organ systemapproach.RadioGraphics.
2002 Oct;22 Spec No:S119-35
Mégarbane B,
Chevillard L.
The large spectrum of pulmonary complications
following illicit drug use: features and mechanisms.
Chem Biol Interact.
2013 Dec 5;206(3):444-51
Nguyen ET,
Silva CI,
Souza...