CTICasesMethylcellulose Excipient Lung Disease
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Imaging findings
High-resolution chest CT demonstrates extensive, diffuse, tree-in-bud nodularity and micronodules involving the entirety of both lungs from the apex to the base. Additionally, there is enlargement of the right ventricle and main pulmonary artery, consistent with severe pulmonary hypertension.
Key takeaways
Extensive, diffuse, pan-lobar tree-in-bud nodularity in an intravenous drug user is highly suggestive of excipient lung disease rather than infectious bronchiolitis. This process is caused by the microembolization of crushed oral tablets containing binders such as methylcellulose or talc, which leads to foreign body granulomatosis and severe pulmonary hypertension.
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