CTICasesExcipient Lung Disease from Intravenous Oxycodone Abuse
Imaging findings
Chest radiograph shows fine, diffuse stippling throughout both lungs. High-resolution CT demonstrates sharp, discrete, very small centrilobular nodules with relative sparing of the peripheral lung margins and no clustering along the fissures. Mediastinal windows show right ventricular enlargement and a dilated pulmonary artery, indicating secondary pulmonary hypertension.
Key takeaways
Excipient lung disease occurs from the intravenous injection of crushed oral tablets, which contain non-soluble filler materials such as talc, starch, or microcrystalline cellulose. The discrete, sharp appearance of the centrilobular nodules on CT reflects their vascular-associated granulomatous nature, rather than an airway-related etiology, and can progress to severe, potentially lethal pulmonary hypertension.
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