CTICasesExcipient Lung Disease
Imaging findings
Initial CT (2008) showed numerous centrilobular nodules, sparing the pleura and diffusely and symmetrically distributed throughout all lobes. A more recent CT shows these centrilobular nodules have increased in size with areas of confluence, forming a dramatic centrilobular or 'tree-in-bud' pattern. Pulmonary artery enlargement is also noted. Lung biopsy confirmed scattered particulate matter with cellulose.
Key takeaways
This patient had inflammatory bowel disease, short gut syndrome, and was on TPN. Excipient lung disease, typically associated with intravenous drug use, can also occur in patients receiving TPN, possibly due to particulate matter in the infusions, or sometimes reflecting an undisclosed history of illicit drug use. The characteristic centrilobular pattern, especially on MIPS, helps identify involved pulmonary arterioles.
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