Here is a CT of this patient. With this plus a close look at the clinical information you should think of a diagnosis.
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Well done friends.
The findings in our case are:
Chest radiograph. Ground glass opacity in right upper lobe. NO cardiomegaly or other findings.
The CT confirms and correlates the presence of an air space pathology in the right upper lobe.
HRCT. The ground glass in the right upper lobe is better identified with thing slices showing interlobar thickening within the ground glass density. This is the typical “crazy paving” pattern.
Comment: The findings indicate an air space pathology with some interstitial involvement (interlobular septae).
Many diseases may produce this type of pattern ( crazy paving) thus it’s very important to correlate the clinical information with the imaging findings. In this case the clinical data that could help make the diagnosis are:
- Young patient
- No previous diseases
- Week end episode
With all these findings in mind we arrived to the diagnosis of Crack or Cocaine induced disease Lung.
Pulmonary haemorrhage occurs as a complication of cocaine abuse. It may present clinically with haemoptysis and dyspnoea
The pulmonary manifestations of this pathology have been related to Levamisol that is often used as an adulterant or bulk with cocaine. This drug is an immunomodulatory agent previously used to treat cancer and later as an antiparasitary drug. It produces agranulocytosis and induces autoimmunity reactions and vasculitis. ( Almeida et al 2007).
The chest radiographs may present with unilateral or bilateral ground glass densities and the CT will show ground glass opacities, generally diffuse, with interlobular septal thickening (crazy paving pattern). Other findings that have been described are centrilobular nodules and tree in bud.
In our case the disease was localized while it’s more common to see it in a diffuse pattern presentation. In those cases, dyspnoea is usually present.
Tip: Always try to correlate the findings with every detail of the clinical information.
A couple of papers related to Cocaine induced pulmonary disease.