Crack lung is a term used to describe an acute pulmonary injury related to smoked crack cocaine.
On imaging, it is characterized by interstitial and alveolar lung opacities with a diffuse distribution and commonly involving the perihilar regions.
Patients present with sympathetic hyperactivity such as tachycardia, hypertension, dilated pupils, and chest pain, productive cough, dyspnea, and hypoxemia along with fever, hemoptysis, and respiratory failure 1,3.
Histological changes include 1:
- diffuse alveolar damage
- alveolar hemorrhage
- interstitial/alveolar infiltration by inflammatory cells, typically eosinophils as well as peripheral eosinophilia (up to 40%)
Plain radiograph and CT
Reported features are nonspecific and include 2,3,4:
- pulmonary alveolar and interstitial edema, predominantly perihilar
- pulmonary hemorrhage
- barotrauma: pneumothorax; pneumomediastinum; pneumopericardium
- localized atelectasis or consolidation
- empyema rich in eosinophils
Treatment and prognosis
Mild cases resolve with conservative management and severe cases are usually treated with corticosteroids 1.
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- 2. Hagan IG, Burney K. Radiology of recreational drug abuse. Radiographics. 2007;27 (4): 919-40. doi:10.1148/rg.274065103 - Pubmed citation
- 3. Mançano A, Marchiori E, Zanetti G et-al. Pulmonary complications of crack cocaine use: high-resolution computed tomography of the chest. J Bras Pneumol.34 (5): 323-7. doi:10.1590/S1806-37132008000500012 - Pubmed citation
- 4. Wright FW. Radiology of the chest and related conditions. CRC Press. ISBN:0415281415. Read it at Google Books - Find it at Amazon
- 5. Restrepo CS, Carrillo JA, Martínez S et-al. Pulmonary complications from cocaine and cocaine-based substances: imaging manifestations. Radiographics. 2007;27 (4): 941-56. doi:10.1148/rg.274065144 - Pubmed citation