CTICasesExcipient Lung Disease with Pulmonary Hypertension
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Imaging findings
A young female with Crohn's disease, opiate dependence, and an indwelling central line presented with subtle, fine reticular nodular opacities, predominantly centrilobular and not touching the pleura, on chest imaging. These nodules were new compared to a prior CT, which also showed new right ventricular enlargement and septal bowing, indicative of elevated pulmonary pressures.
Key takeaways
Excipient lung disease, caused by intravenous injection of crushed oral tablets, is characterized by centrilobular nodules and is a known cause of pulmonary hypertension due to granulomatous angiopathy. This diagnosis should be strongly considered in patients with a history of IV drug abuse and unexplained lung nodules, particularly if associated with signs of right heart strain, to avoid misdiagnosis as miliary infection.
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