CTICasesInjection-Related Talc Granulomatosis
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Imaging findings
High-resolution chest CT shows severe, lower-lobe predominant centrilobular emphysema with bronchial wall thickening. Histopathologic analysis of the explanted lung following transplant reveals extensive intravascular and interstitial polarizable foreign material (talc) associated with foreign-body giant cell granulomas.
Key takeaways
Intravenous injection of crushed oral tablets (such as Ritalin or methadone) leads to the embolization of insoluble excipient materials, most commonly talc, into the pulmonary microvasculature. This results in progressive foreign-body granulomatosis and severe, lower-lobe predominant emphysema that closely mimics alpha-1 antitrypsin deficiency on imaging. Clinicians must maintain a high index of suspicion in patients with unexplained basilar emphysema, even when patients deny drug abuse.
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