CTICasesIntravenous Talcosis
Imaging findings
Serial chest radiographs show progressive, severe enlargement of the main and branch pulmonary arteries, and dilatation of the right heart chambers. Chest CT and MIP reconstructions demonstrate extensive, diffuse bilateral centrilobular nodular and branching arterial-centered opacities. Background findings include an indwelling vascular catheter in the left upper extremity. All findings are consistent with severe pulmonary arterial hypertension secondary to intravenous talcosis.
Key takeaways
Intravenous talcosis (excipient lung disease) is caused by the intravenous injection of crushed oral medication tablets (such as methylphenidate or methadone) that contain insoluble fillers like talc, microcrystalline cellulose, or cornstarch. These particles embolize to the pulmonary arterioles, evoking a foreign-body granulomatous reaction. This leads to vascular occlusion, progressive pre-capillary pulmonary hypertension, and right-sided heart failure.
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