CTICasesSuspected Excipient Lung Disease (TPN vs. Undisclosed Injections)
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Imaging findings
Current CT, initially performed for abdomen and pelvis, revealed diffuse centrolobular nodules in the lungs. A prior CT from 2008 showed the onset of this process, with biopsy demonstrating foreign body granulomas and polarizable material. Over several years, the condition worsened. The airways appeared normal, and there was no evidence of right heart enlargement.
Key takeaways
Diffuse centrolobular nodules with foreign body granulomas and polarizable material are characteristic of excipient lung disease. While injection of illicit substances is a primary consideration, the potential for total parenteral nutrition (TPN) to cause pulmonary crystalline deposition and excipient lung disease is a rare and debated possibility, particularly when the timeline of lung changes does not definitively correlate with TPN initiation or in the absence of significant pulmonary hypertension. Thorough patient questioning regarding injection history is critical.
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