CTICasesRitalin Lung (Talc-Induced Panlobular Emphysema)
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Imaging findings
Chest CT demonstrates severe, bilateral, lower-lung-predominant panlobular emphysema. The lung parenchyma in the bases shows a uniform, diffuse decreased attenuation (blackness) with splaying of the pulmonary vessels, rather than the focal, discrete holes classically associated with centrilobular emphysema. There is also associated atelectasis and scarring along the major fissures in the mid-lungs.
Key takeaways
Intravenous injection of crushed Ritalin (methylphenidate) tablets can lead to a distinct form of excipient lung disease known as "Ritalin lung," which is characterized by basilar-predominant panlobular emphysema. This process is chemically driven by talc, which was historically used as an inactive tablet binder. Instead of causing a restrictive granulomatous vasculitis like microcrystalline cellulose, the talc particles accumulate in the lung, stimulating alveolar macrophages to release elastases and proteases. Because the macrophages cannot digest the talc, they undergo lysis and spill their digestive enzymes, leading to destruction of the alveolar walls in a pattern that virtually mirrors alpha-1 antitrypsin deficiency.
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