CTICasesForeign Body Granulomatosis (Excipient Lung Disease)
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Imaging findings
A 31-year-old female presented with hypoxemia and diffuse micronodular lung disease. CT showed diffuse micronodules throughout both lungs. Biopsy revealed foreign body granulomas within pulmonary vessels, and MIP reconstruction confirmed these opacities were related to the pulmonary arterial tree. This was consistent with granulomatosis from the intravenous injection of crushed narcotic tablets (oxycodone) containing microcrystalline cellulose.
Key takeaways
Diffuse micronodular lung disease in the setting of intravenous drug abuse is often secondary to foreign body granulomatosis from excipients like talc or microcrystalline cellulose. MIP reconstructions can help demonstrate the vascular distribution of these nodules, connecting them to pulmonary artery branches.
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