CTICasesExcipient Lung Disease
Imaging findings
Serial chest CT scans obtained one week apart in a patient with a history of intravenous drug abuse show a rapid, marked enlargement of the right atrium and right ventricle, septal flattening, and a dramatic increase in the size and number of diffuse, bilateral centrilobular ground-glass nodules and subsegmental tree-in-bud opacities along the pulmonary arteriole branches.
Key takeaways
Excipient lung disease (pulmonary talcosis/starch granulomatosis) is caused by the intravenous injection of crushed oral tablets. The insoluble filler materials (talc, microcrystalline cellulose, starch) embolize to the pulmonary microvasculature, triggering a foreign-body granulomatous reaction. On CT, this presents as rapidly progressive, diffuse centrilobular and tree-in-bud nodules that track along the arterioles, leading to acute pulmonary hypertension and right heart strain.
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