CTICasesRitalin (Intravenous Methylphenidate) Lung with Basilar Panlobular Emphysema
Imaging findings
A cigarette smoker with a history of intravenous Ritalin (methylphenidate) abuse had modest upper-lung emphysema but striking, confluent basal emphysema on CT, with loss of the usual discrete holes and transitions between abnormal and normal lung because the emphysema extended wall-to-wall to the edges of the secondary pulmonary lobules; the main clue to its presence was diffuse attenuation and spreading of the pulmonary vasculature rather than discrete lucent holes. Alpha-1-antitrypsin testing was normal.
Key takeaways
Basal-predominant, confluent panlobular emphysema in a patient with a history of injecting crushed oral tablets (such as Ritalin) should suggest talc/excipient-related lung injury even when alpha-1-antitrypsin deficiency has been excluded. When emphysema becomes very confluent and extends to the lobular margins, the discrete holes typical of centrilobular emphysema are lost and the disease can be under-recognized, with attenuated, sparse pulmonary vasculature becoming the main imaging clue.
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