CTICasesExcipient Lung Disease and Aspiration Pneumonitis (Heroin and Crushed Pills, Vegetable Material)
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Imaging findings
Initial chest radiograph showed subtle nodular opacities, which evolved into more reticular-nodular opacities with numerous "lines" by the next day. CT revealed extensive centrolobular nodules distributed throughout the lungs, complicated by bronchial wall thickening and luminal debris in the lower lobe airways. An open lung biopsy confirmed the presence of foreign body granulomas and exogenous vegetable material within the airways.
Key takeaways
Intravenous injection of substances like heroin and crushed pills can cause excipient lung disease, characterized by extensive centrolobular nodules. In cases of overdose with witnessed aspiration, the presence of foreign body granulomas and exogenous vegetable material in the airways can further complicate the presentation, leading to bronchial wall thickening and an airway-centered process. The diffuse nature of the nodules suggests a combined intravascular and aspirational etiology.
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