CTICasesCocaine-Associated Cardiomyopathy with Hydrostatic Pulmonary Edema
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Imaging findings
Chest radiographs show bilateral interstitial lung edema with prominent septal lines, subpleural interstitial edema along the interlobar fissures, and peribronchial fluid cuffing. The intermediate stem bronchus is thickened on the lateral view due to a peribronchial fluid cuff. The heart is enlarged. Cardiac MRI demonstrates severely depressed left ventricular contractile function without delayed enhancement to suggest myocardial infarction.
Key takeaways
Cocaine abuse can lead to non-ischemic cardiomyopathy with acute left ventricular failure. The chest radiographic findings are classic for hydrostatic pulmonary edema, characterized by septal lines, subpleural fluid, peribronchial cuffing, and cardiomegaly. Cardiac MRI is useful to rule out ischemic cardiomyopathy by assessing for the presence of delayed myocardial enhancement.
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