Ritalin lung

Discussion:

Panlobular emphysema of the bilateral lower lobes due to complete destruction of secondary pulmonary lobules. Lower lobe predominance indicates a hematogenous insult. 

The differential diagnosis for bilateral lower lung panlobular emphysema is alpha-1-antitrypsin deficiency and talc-containing Ritalin (methylphenidate) injection. 

This patient had a documented history of Ritalin injection, causing the so-called Ritalin lung

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