CTICasesMethamphetamine Inhalation Lung Injury
Imaging findings
A man in his early 40s presented short of breath with an enlarged heart and bilateral blobs that worsened over two days then cleared dramatically. CT between the radiographs shows a classic organizing pneumonia pattern with ground-glass cores and denser rims (reverse halo signs), plus pleural and pericardial effusions, an enlarged left and right ventricle, and a large pulmonary artery. His ejection fraction was 18 to 19 percent, and he admitted recent methamphetamine use (mostly inhaled, previously intravenous), with prior cocaine use.
Key takeaways
Methamphetamine inhalation can cause an organizing pneumonia pattern of lung injury (and pulmonary hemorrhage), here superimposed on a newly diagnosed drug-related cardiomyopathy; the rapidly clearing component reflected heart failure responding to diuresis and afterload reduction, leaving behind the organizing pneumonia. Drug-related lung injury should be considered when the pattern does not fit infection, though the history is often unreliable, and this can be difficult to distinguish from EVALI.
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