CTICasesExcipient Lung Disease from Methylphenidate or OxyContin Injection
▶ Watch on YouTube — age-restricted, cannot embed here
Imaging findings
Chest CT shows a very fine, diffuse nodular pattern throughout the lungs. The nodules are centrilobular and trace along the vascular tree, creating a vascular "tree-in-bud" appearance that is particularly prominent on maximum intensity projection (MIP) reconstructions. Additional findings include a dilated pulmonary artery indicating pulmonary hypertension, basilar atelectasis, and stable, long-standing mediastinal and hilar lymphadenopathy.
Key takeaways
Intravenous injection of crushed oral tablets, such as OxyContin or methadone, can result in excipient lung disease. The inactive tablet binders (excipients), such as microcrystalline cellulose, lodge in the pulmonary microvasculature and trigger an exuberant granulomatous vasculitis. MIP reconstructions are highly useful in these cases to demonstrate that the centrilobular nodules are angiocentric, tracking specifically along the intralobular pulmonary artery branches rather than the pulmonary veins. This progressive vascular obstruction can cause severe pulmonary hypertension and can be fatal.
AI-assisted summary — may contain errors. Verify against the source video. Learn more
More from this webinar
- Extrapleural Chest Wall LipomaNeoplastic
- Ritalin Lung (Talc-Induced Panlobular Emphysema)Exposure
- Acute Infectious Discitis and Epidural AbscessInfection
- Primary Pulmonary HemosiderosisOther
- King Supraglottic Airway DeviceArtifact
- Ectopic Parathyroid ParagangliomaNeoplastic
- SDH-Mutation Related Multicentric ParagangliomasNeoplastic
- Primary Mediastinal Non-Seminomatous Germ Cell TumorNeoplastic
See all cases from February 13, 2015 →