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Lee J, Bambrick M, Lau A, Tarlo SM, McInnis M. Computed Tomography of Contemporary Occupational Lung Disease: A Pictorial Review. Diagnostics (Basel) 2024; 14:1786. [PMID: 39202274 PMCID: PMC11353255 DOI: 10.3390/diagnostics14161786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2024] [Revised: 08/07/2024] [Accepted: 08/10/2024] [Indexed: 09/03/2024] Open
Abstract
Occupational lung disease remains one of the most common work-related illnesses and accounts for most deaths from occupational illness. Occupational lung diseases often have delayed manifestation over decades and nonspecific clinical presentations, making it challenging for clinicians to promptly identify the disease and implement preventive measures. Radiologists play a crucial role in identifying and diagnosing occupational lung diseases, allowing for removal of the exposure and early medical intervention. In this review, we share our clinical and radiologic approach to diagnosing occupational lung disease and its subtypes. A collection of sample cases of occupational lung diseases commonly encountered in the modern era at a large Canadian university hospital is included to facilitate understanding. This review will provide radiologists with valuable insights into recognizing and diagnosing occupational lung diseases.
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Affiliation(s)
- Jimin Lee
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada
| | - Marie Bambrick
- Department of Medical Imaging, Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A1, Canada
- Department of Medical Imaging, Toronto General Hospital, Toronto, ON M5G 2C4, Canada
| | - Ambrose Lau
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada
- Division of Respirology, University Health Network, Toronto, ON M5T 2S8, Canada
| | - Susan M. Tarlo
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada
- Division of Respirology, University Health Network, Toronto, ON M5T 2S8, Canada
| | - Micheal McInnis
- Department of Medical Imaging, Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A1, Canada
- Department of Medical Imaging, Toronto General Hospital, Toronto, ON M5G 2C4, Canada
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2
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Gann LS, Kunin JR, Ebada M, Walker CM. Spectrum of Thoracic Imaging Findings in the Setting of Substance Abuse. J Comput Assist Tomogr 2024; 48:394-405. [PMID: 38271535 DOI: 10.1097/rct.0000000000001579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2024]
Abstract
ABSTRACT Substance abuse continues to be prevalent nationwide and can lead to a myriad of chest pathologies. Imaging findings are vast and can include nodules, masses, ground-glass opacities, airspace disease, and cysts. Radiologists with awareness of these manifestations can assist in early identification of disease in situations where information is unable to be obtained from the patient. This review focuses on thoracic imaging findings associated with various forms of substance abuse, which are organized by portal of entry into the thorax: inhalation, ingestion, and injection.
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Affiliation(s)
- Lauren S Gann
- From the Department of Radiology, University of Missouri, Columbia, MO
| | - Jeffrey R Kunin
- From the Department of Radiology, University of Missouri, Columbia, MO
| | - Mohamed Ebada
- From the Department of Radiology, University of Missouri, Columbia, MO
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3
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Asif H, Braman SS. Combined Pulmonary Fibrosis and Emphysema in a Patient With Chronic Occupational Exposure to Trichloroethylene. Mil Med 2024; 189:e907-e910. [PMID: 37769213 DOI: 10.1093/milmed/usad359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 08/27/2023] [Accepted: 09/01/2023] [Indexed: 09/30/2023] Open
Abstract
Combined pulmonary fibrosis and emphysema (CPFE) is a clinical syndrome of upper-zone-predominant emphysema on high-resolution CT and a peripheral and basal-predominant diffuse pulmonary fibrosis. Multiple occupational and inhalational exposures have been associated with CPFE. We describe a U.S. veteran, who developed CPFE after a prolonged, intense exposure to trichloroethylene as an aircraft maintenance worker. We believe that this may be another example of occupational-associated CPFE.
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Affiliation(s)
- Huda Asif
- Department of Medicine, The University of Miami, Miller School of Medicine Palm Beach Regional Campus, Atlantis, FL 33462, USA
| | - Sidney S Braman
- Department of Medicine, West Palm Beach Medical Center, West Palm Beach, FL 33410, USA
- Department of Medicine, Icahn School of Medicine at Mount Sinai New York, NY 10029, USA
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4
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Samynathan A, Saardi K, Akiska YM, Sadur A, Johnson S, Nasseri M. "Skin Popping" and "Shooter's Patch" As Manifestations of Intradermal Drug Abuse. Cureus 2023; 15:e45251. [PMID: 37842500 PMCID: PMC10576613 DOI: 10.7759/cureus.45251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/13/2023] [Indexed: 10/17/2023] Open
Abstract
Talc, a common adulterant in injectable opioids and filler in oral tablets, is frequently abused as crushed suspensions in injections. This review aims to recognize intradermal drug injection referred to colloquially as "skin popping" or "shooter's patch" as a cause of granulomatous disease and prevention of systemic complications from cutaneous cues.
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Affiliation(s)
- Archana Samynathan
- Department of Dermatology, George Washington University School of Medicine and Health Sciences, Washington, D.C., USA
- Department of Dermatology, Bangalore Medical College and Research Institute, Bangalore, IND
| | - Kaarl Saardi
- Department of Dermatology, George Washington University School of Medicine and Health Sciences, Washington, D.C., USA
| | - Yagiz M Akiska
- Department of Dermatology, George Washington University School of Medicine and Health Sciences, Washington, D.C., USA
| | - Alana Sadur
- Department of Dermatology, George Washington University School of Medicine and Health Sciences, Washington, D.C., USA
| | - Skylar Johnson
- Department of Dermatology, George Washington University School of Medicine and Health Sciences, Washington, D.C., USA
| | - Mana Nasseri
- Department of Dermatology, George Washington University School of Medicine and Health Sciences, Washington, D.C., USA
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5
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Saeed H, Marmolejos L, Patel R, Shankar T, Latif A, Naqi M, Farrer W, Remolina C. Pleurisy secondary to nonthrombotic pulmonary emboli in a patient with intravenous drug use. Respir Med Case Rep 2023; 45:101884. [PMID: 37577124 PMCID: PMC10415754 DOI: 10.1016/j.rmcr.2023.101884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Revised: 05/09/2023] [Accepted: 05/31/2023] [Indexed: 08/15/2023] Open
Abstract
Patients with injection drug use can have nonthrombotic pulmonary emboli (NTPE) of foreign insoluble particles that are either parts of the equipment used or mixed with the drug as an additive. These foreign particles can become a nidus for infection and inflammation. We present a case of a 31-year-old man with active intravenous drug use who initially presented with signs and symptoms of pleurisy and was found to have NTPE of septic refractile crystalline material as seen on bronchial wash and brush biopsy. We believe our patient likely had embolism of either crack particles, needle fragments or cotton-wool fragments that led to a localized inflammatory reaction and infection. This highlights the importance of obtaining detailed history and diagnostic workup. Once the diagnoses of bacterial endocarditis and thrombophlebitis are ruled out with blood cultures, transthoracic echocardiogram, trans-esophageal echocardiogram and/or CT scan (depending on the suspicion), NTPE should be considered and bronchoscopy with bronchoalveolar lavage with biopsy should be performed.
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Affiliation(s)
- Hasham Saeed
- RWJBarnabas Health, Trinitas Regional Medical Center, 225 Williamson St., Elizabeth, NJ, 07202, USA
| | - Leonardo Marmolejos
- RWJBarnabas Health, Trinitas Regional Medical Center, 225 Williamson St., Elizabeth, NJ, 07202, USA
| | - Roma Patel
- RWJBarnabas Health, Trinitas Regional Medical Center, 225 Williamson St., Elizabeth, NJ, 07202, USA
| | - Tanya Shankar
- RWJBarnabas Health, Trinitas Regional Medical Center, 225 Williamson St., Elizabeth, NJ, 07202, USA
| | - Asnia Latif
- RWJBarnabas Health, Trinitas Regional Medical Center, 225 Williamson St., Elizabeth, NJ, 07202, USA
| | - Muniba Naqi
- RWJBarnabas Health, Trinitas Regional Medical Center, 225 Williamson St., Elizabeth, NJ, 07202, USA
| | - William Farrer
- RWJBarnabas Health, Trinitas Regional Medical Center, 225 Williamson St., Elizabeth, NJ, 07202, USA
| | - Carlos Remolina
- RWJBarnabas Health, Trinitas Regional Medical Center, 225 Williamson St., Elizabeth, NJ, 07202, USA
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6
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Valeyre D, Brauner M, Bernaudin JF, Carbonnelle E, Duchemann B, Rotenberg C, Berger I, Martin A, Nunes H, Naccache JM, Jeny F. Differential diagnosis of pulmonary sarcoidosis: a review. Front Med (Lausanne) 2023; 10:1150751. [PMID: 37250639 PMCID: PMC10213276 DOI: 10.3389/fmed.2023.1150751] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 04/24/2023] [Indexed: 05/31/2023] Open
Abstract
Diagnosing pulmonary sarcoidosis raises challenges due to both the absence of a specific diagnostic criterion and the varied presentations capable of mimicking many other conditions. The aim of this review is to help non-sarcoidosis experts establish optimal differential-diagnosis strategies tailored to each situation. Alternative granulomatous diseases that must be ruled out include infections (notably tuberculosis, nontuberculous mycobacterial infections, and histoplasmosis), chronic beryllium disease, hypersensitivity pneumonitis, granulomatous talcosis, drug-induced granulomatosis (notably due to TNF-a antagonists, immune checkpoint inhibitors, targeted therapies, and interferons), immune deficiencies, genetic disorders (Blau syndrome), Crohn's disease, granulomatosis with polyangiitis, eosinophilic granulomatosis with polyangiitis, and malignancy-associated granulomatosis. Ruling out lymphoproliferative disorders may also be very challenging before obtaining typical biopsy specimen. The first step is an assessment of epidemiological factors, notably the incidence of sarcoidosis and of alternative diagnoses; exposure to risk factors (e.g., infectious, occupational, and environmental agents); and exposure to drugs taken for therapeutic or recreational purposes. The clinical history, physical examination and, above all, chest computed tomography indicate which differential diagnoses are most likely, thereby guiding the choice of subsequent investigations (e.g., microbiological investigations, lymphocyte proliferation tests with metals, autoantibody assays, and genetic tests). The goal is to rule out all diagnoses other than sarcoidosis that are consistent with the clinical situation. Chest computed tomography findings, from common to rare and from typical to atypical, are described for sarcoidosis and the alternatives. The pathology of granulomas and associated lesions is discussed and diagnostically helpful stains specified. In some patients, the definite diagnosis may require the continuous gathering of information during follow-up. Diseases that often closely mimic sarcoidosis include chronic beryllium disease and drug-induced granulomatosis. Tuberculosis rarely resembles sarcoidosis but is a leading differential diagnosis in regions of high tuberculosis endemicity.
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Affiliation(s)
- Dominique Valeyre
- Pulmonology Department, Groupe Hospitalier Paris Saint Joseph, Paris, France
- INSERM UMR 1272, Sorbonne University Paris-Nord, Paris, France
| | - Michel Brauner
- Radiology Department, Avicenne University Hospital, Bobigny, France
| | - Jean-François Bernaudin
- INSERM UMR 1272, Sorbonne University Paris-Nord, Paris, France
- Faculté de Médecine, Sorbonne University Paris, Paris, France
| | | | - Boris Duchemann
- INSERM UMR 1272, Sorbonne University Paris-Nord, Paris, France
- Thoracic and Oncology Department, Avicenne University Hospital, Bobigny, France
| | - Cécile Rotenberg
- INSERM UMR 1272, Sorbonne University Paris-Nord, Paris, France
- Pulmonology Department, Avicenne University Hospital, Bobigny, France
| | - Ingrid Berger
- Pulmonology Department, Groupe Hospitalier Paris Saint Joseph, Paris, France
| | - Antoine Martin
- Pathology Department, Avicenne University Hospital, Bobigny, France
| | - Hilario Nunes
- INSERM UMR 1272, Sorbonne University Paris-Nord, Paris, France
- Pulmonology Department, Avicenne University Hospital, Bobigny, France
| | - Jean-Marc Naccache
- Pulmonology Department, Groupe Hospitalier Paris Saint Joseph, Paris, France
| | - Florence Jeny
- INSERM UMR 1272, Sorbonne University Paris-Nord, Paris, France
- Pulmonology Department, Avicenne University Hospital, Bobigny, France
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7
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Gredic M, Karnati S, Ruppert C, Guenther A, Avdeev SN, Kosanovic D. Combined Pulmonary Fibrosis and Emphysema: When Scylla and Charybdis Ally. Cells 2023; 12:1278. [PMID: 37174678 PMCID: PMC10177208 DOI: 10.3390/cells12091278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 04/17/2023] [Accepted: 04/26/2023] [Indexed: 05/15/2023] Open
Abstract
Combined pulmonary fibrosis and emphysema (CPFE) is a recently recognized syndrome that, as its name indicates, involves the existence of both interstitial lung fibrosis and emphysema in one individual, and is often accompanied by pulmonary hypertension. This debilitating, progressive condition is most often encountered in males with an extensive smoking history, and is presented by dyspnea, preserved lung volumes, and contrastingly impaired gas exchange capacity. The diagnosis of the disease is based on computed tomography imaging, demonstrating the coexistence of emphysema and interstitial fibrosis in the lungs, which might be of various types and extents, in different areas of the lung and several relative positions to each other. CPFE bears high mortality and to date, specific and efficient treatment options do not exist. In this review, we will summarize current knowledge about the clinical attributes and manifestations of CPFE. Moreover, we will focus on pathophysiological and pathohistological lung phenomena and suspected etiological factors of this disease. Finally, since there is a paucity of preclinical research performed for this particular lung pathology, we will review existing animal studies and provide suggestions for the development of additional in vivo models of CPFE syndrome.
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Affiliation(s)
- Marija Gredic
- Cardio-Pulmonary Institute (CPI), Universities of Giessen and Marburg Lung Center (UGMLC), Member of the German Center for Lung Research (DZL), Justus Liebig University, 35392 Giessen, Germany
| | - Srikanth Karnati
- Institute for Anatomy and Cell Biology, Julius-Maximilians-University Würzburg, 97070 Würzburg, Germany
| | - Clemens Ruppert
- Cardio-Pulmonary Institute (CPI), Universities of Giessen and Marburg Lung Center (UGMLC), Member of the German Center for Lung Research (DZL), Justus Liebig University, 35392 Giessen, Germany
- UGMLC Giessen Biobank & European IPF Registry/Biobank, 35392 Giessen, Germany
| | - Andreas Guenther
- Cardio-Pulmonary Institute (CPI), Universities of Giessen and Marburg Lung Center (UGMLC), Member of the German Center for Lung Research (DZL), Justus Liebig University, 35392 Giessen, Germany
- UGMLC Giessen Biobank & European IPF Registry/Biobank, 35392 Giessen, Germany
- Institute for Lung Health (ILH), 35392 Giessen, Germany
- Lung Clinic, Evangelisches Krankenhaus Mittelhessen, 35398 Giessen, Germany
| | - Sergey N. Avdeev
- Department of Pulmonology, I.M. Sechenov First Moscow State Medical University (Sechenov University), 119991 Moscow, Russia
| | - Djuro Kosanovic
- Department of Pulmonology, I.M. Sechenov First Moscow State Medical University (Sechenov University), 119991 Moscow, Russia
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8
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Rich KM, Solomon DA. Medical Complications of Injection Drug Use - Part II. NEJM EVIDENCE 2023; 2:EVIDra2300019. [PMID: 38320028 DOI: 10.1056/evidra2300019] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2024]
Abstract
Medical Complications of Injection Drug Use - Part IIDuring the past 2 decades, the risk of death, as well as the prevalence of hospitalizations in the United States, has increased substantially among people who inject drugs, mainly because of the opioid epidemic. In Part Two of this two-part review, the authors review complications observed in people who inject drugs and strategies to reduce harm.
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Affiliation(s)
| | - Daniel A Solomon
- Harvard Medical School, Boston
- Division of Infectious Diseases, Brigham and Women's Hospital, Boston
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9
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Cottin V, Selman M, Inoue Y, Wong AW, Corte TJ, Flaherty KR, Han MK, Jacob J, Johannson KA, Kitaichi M, Lee JS, Agusti A, Antoniou KM, Bianchi P, Caro F, Florenzano M, Galvin L, Iwasawa T, Martinez FJ, Morgan RL, Myers JL, Nicholson AG, Occhipinti M, Poletti V, Salisbury ML, Sin DD, Sverzellati N, Tonia T, Valenzuela C, Ryerson CJ, Wells AU. Syndrome of Combined Pulmonary Fibrosis and Emphysema: An Official ATS/ERS/JRS/ALAT Research Statement. Am J Respir Crit Care Med 2022; 206:e7-e41. [PMID: 35969190 PMCID: PMC7615200 DOI: 10.1164/rccm.202206-1041st] [Citation(s) in RCA: 73] [Impact Index Per Article: 36.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: The presence of emphysema is relatively common in patients with fibrotic interstitial lung disease. This has been designated combined pulmonary fibrosis and emphysema (CPFE). The lack of consensus over definitions and diagnostic criteria has limited CPFE research. Goals: The objectives of this task force were to review the terminology, definition, characteristics, pathophysiology, and research priorities of CPFE and to explore whether CPFE is a syndrome. Methods: This research statement was developed by a committee including 19 pulmonologists, 5 radiologists, 3 pathologists, 2 methodologists, and 2 patient representatives. The final document was supported by a focused systematic review that identified and summarized all recent publications related to CPFE. Results: This task force identified that patients with CPFE are predominantly male, with a history of smoking, severe dyspnea, relatively preserved airflow rates and lung volumes on spirometry, severely impaired DlCO, exertional hypoxemia, frequent pulmonary hypertension, and a dismal prognosis. The committee proposes to identify CPFE as a syndrome, given the clustering of pulmonary fibrosis and emphysema, shared pathogenetic pathways, unique considerations related to disease progression, increased risk of complications (pulmonary hypertension, lung cancer, and/or mortality), and implications for clinical trial design. There are varying features of interstitial lung disease and emphysema in CPFE. The committee offers a research definition and classification criteria and proposes that studies on CPFE include a comprehensive description of radiologic and, when available, pathological patterns, including some recently described patterns such as smoking-related interstitial fibrosis. Conclusions: This statement delineates the syndrome of CPFE and highlights research priorities.
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Affiliation(s)
- Vincent Cottin
- National Reference Center for Rare Pulmonary Diseases, Louis Pradel Hospital, Hospices Civils de Lyon, University of Lyon, INRAE, Lyon, France
| | - Moises Selman
- Instituto Nacional de Enfermedades Respiratorias “Ismael Cosío Villegas”, Mexico City, Mexico
| | | | | | - Tamera J. Corte
- Royal Prince Alfred Hospital and University of Sydney, Sydney, Australia
| | | | | | - Joseph Jacob
- University College London, London, United Kingdom
| | - Kerri A. Johannson
- Department of Medicine and Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | | | - Joyce S. Lee
- University of Colorado Denver Anschutz Medical Campus, School of Medicine, Aurora, CO, USA
| | - Alvar Agusti
- Respiratory Institute, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERES, Barcelona, Spain
| | - Katerina M. Antoniou
- Laboratory of Molecular and Cellular Pneumonology, Department of Respiratory Medicine, University of Crete, Heraklion, Greece
| | | | - Fabian Caro
- Hospital de Rehabilitación Respiratoria "María Ferrer", Buenos Aires, Argentina
| | | | - Liam Galvin
- European idiopathic pulmonary fibrosis and related disorders federation
| | - Tae Iwasawa
- Kanagawa Cardiovascular and Respiratory Center, Yokohama, Japan
| | | | | | | | - Andrew G. Nicholson
- Royal Brompton and Harefield Hospitals, Guy’s and St Thomas’ NHS Foundation Trust and National Heart and Lung Institute, Imperial College, London, United Kingdom
| | | | | | | | - Don D. Sin
- University of British Columbia, Vancouver, Canada
| | - Nicola Sverzellati
- Scienze Radiologiche, Department of Medicine and Surgery, University of Parma, Italy
| | - Thomy Tonia
- Institute of Social and Preventive Medicine, University of Bern, Switzerland
| | - Claudia Valenzuela
- Pulmonology Department, Hospital Universitario de la Princesa, Departamento Medicina, Universidad Autónoma de Madrid, 28049 Madrid, Spain
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10
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Rasul TF, Bergholz DR, Rovinski R, Gulraiz S, Fonts E. Combined Pulmonary Fibrosis and Emphysema and Digital Clubbing. Cureus 2022; 14:e24231. [PMID: 35602819 PMCID: PMC9115620 DOI: 10.7759/cureus.24231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/18/2022] [Indexed: 11/23/2022] Open
Abstract
Combined pulmonary fibrosis and emphysema (CPFE) is an underrecognized syndrome that involves simultaneous restrictive-obstructive lung disease. The prognosis is poor, and it frequently occurs with comorbidities. Heavy or former smoking is a major risk factor, and computed tomography (CT) typically shows lower zone fibrosis and upper zone emphysema. Chronic respiratory failure, pulmonary hypertension, and lung carcinoma are major causes of mortality. Diagnosis of CPFE should be combined with palliative care due to the high mortality of the condition, especially in the case of delayed diagnosis. We present the case of a 73-year-old male with a history of non-small cell lung cancer, 50 pack-year smoking, and cervical spine injury (CSI) with a late diagnosis of CPFE. After presenting to the emergency department for an acute exacerbation of dyspnea and hypoxia, he was initially treated with a congestive heart failure protocol. Further examination showed mixed pulmonary function tests as well as digital clubbing, and a CT scan showed changes indicative of advanced bullous emphysema diffusely throughout both lungs with an upper lobe predominance and basilar fibrosis. He was diagnosed with CPFE and immediately treated for both restrictive and obstructive lung diseases with supplemental oxygen, albuterol, ipratropium, corticosteroids, systemic antibiotics, as well as provided with palliative consultation. His previous history and CSI delayed diagnosis, as his lung restriction was likely assumed to be from impaired chest wall mobility rather than CPFE. This case highlights the presentation of a relatively rare disease that was confounded by comorbidities.
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11
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Smith BC, Grant T, Allen B. Excipient lung disease in a patient taking the benzodiazepine derivative etizolam: A case report. Radiol Case Rep 2022; 17:1037-1040. [PMID: 35145565 PMCID: PMC8818925 DOI: 10.1016/j.radcr.2022.01.035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 01/15/2022] [Indexed: 11/29/2022] Open
Abstract
Excipient Lung Disease is an inflammatory response to the intravenous administration of oral formulations of drugs and their excipients (additives). Previously described offenders include opioids and Ritalin, whose excipients, when crushed and administered intravenously, lead to inflammation and are demonstrated by centrilobular nodules and ground-glass formations on Chest Computed Tomography. In this case report, we demonstrate Chest CT findings of excipient lung disease in a patient using etizolam, a benzodiazepine derivative commonly used as an anxiolytic in Japan. Of note, the patient acquired etizolam for purchase through online retailers without prescription, which is becoming more common occurrence and offers the additional risk of unknown formulations.
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Affiliation(s)
- Ben C Smith
- Northwestern University Feinberg School of Medicine, Chicago, 676 N St Clair St Ste 800, IL, USA,Corresponding author.
| | - Thomas Grant
- Northwestern University Feinberg School of Medicine, Chicago, 676 N St Clair St Ste 800, IL, USA
| | - Bradley Allen
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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12
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A Man with a History of Intravenous Drug Use and Diffuse Small Nodular Lung Opacities on Imaging. Ann Am Thorac Soc 2021; 18:2079-2083. [PMID: 34851242 DOI: 10.1513/annalsats.202011-1468cc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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13
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Gonçalves TA, Barreto MM, Marchiori E. Pulmonary talcosis related to cocaine inhalation. J Bras Pneumol 2021; 47:e20210146. [PMID: 34190865 PMCID: PMC8332722 DOI: 10.36416/1806-3756/e20210146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | - Edson Marchiori
- . Universidade Federal do Rio de Janeiro. Rio de Janeiro (RJ) Brasil
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14
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Franquet T, Franks TJ, Galvin JR, Marchiori E, Giménez A, Mazzini S, Johkoh T, Lee KS. Non-Infectious Granulomatous Lung Disease: Imaging Findings with Pathologic Correlation. Korean J Radiol 2021; 22:1416-1435. [PMID: 34132073 PMCID: PMC8316771 DOI: 10.3348/kjr.2020.1082] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 10/26/2020] [Accepted: 11/01/2020] [Indexed: 12/14/2022] Open
Abstract
Non-infectious granulomatous lung disease represents a diverse group of disorders characterized by pulmonary opacities associated with granulomatous inflammation, a relatively nonspecific finding commonly encountered by pathologists. Some lesions may present a diagnostic challenge because of nonspecific imaging features; however, recognition of the various imaging manifestations of these disorders in conjunction with patients' clinical history, such as age, symptom onset and duration, immune status, and presence of asthma or cutaneous lesions, is imperative for narrowing the differential diagnosis and determining appropriate management of this rare group of disorders. In this pictorial review, we describe the pathologic findings of various non-infectious granulomatous lung diseases as well as the radiologic features and high-resolution computed tomography imaging features.
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Affiliation(s)
- Tomás Franquet
- Department of Diagnostic Radiology, Hospital de Sant Pau, Universitat Autónoma de Barcelona, Barcelona, Spain.
| | - Teri J Franks
- Department of Defense, Pulmonary & Mediastinal Pathology, The Joint Pathology Center, Silver Spring, MD, USA
| | - Jeffrey R Galvin
- Department of Diagnostic Radiology, Chest Imaging, & Pulmonary Critical Care Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Edson Marchiori
- Department of Radiology, Hospital Universitário Clementino Fraga Filho-Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brasil
| | - Ana Giménez
- Department of Diagnostic Radiology, Hospital de Sant Pau, Universitat Autónoma de Barcelona, Barcelona, Spain
| | - Sandra Mazzini
- Department of Diagnostic Radiology, Hospital de Sant Pau, Universitat Autónoma de Barcelona, Barcelona, Spain
| | - Takeshi Johkoh
- Department of Radiology, Kansai Rosai Hospital, Hyogo, Japan
| | - Kyung Soo Lee
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine (SKKU-SOM), Seoul, Korea
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15
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Masanori A. Imaging diagnosis of classical and new pneumoconiosis: predominant reticular HRCT pattern. Insights Imaging 2021; 12:33. [PMID: 33689008 PMCID: PMC7947097 DOI: 10.1186/s13244-021-00966-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 01/11/2021] [Indexed: 11/16/2022] Open
Abstract
Our understanding of the manifestations of pneumoconioses is evolving in recent years. Associations between novel exposures and diffuse interstitial lung disease have been newly recognized. In advanced asbestosis, two types of fibrosis are seen, probably related to dose of exposure, existence of pleural fibrosis, and the host factor status of the individual. In pneumoconiosis of predominant reticular type, nodular opacities are often seen in the early phase. The nodular pattern is centrilobular, although some in metal lung show perilymphatic distribution, mimicking sarcoidosis. High-resolution computed tomography enables a more comprehensive correlation between the pathologic findings and clinically relevant imaging findings. The clinician must understand the spectrum of characteristic imaging features related to both known dust exposures and to historically recent new dust exposures.
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Affiliation(s)
- Akira Masanori
- Department of Radiology, NHO Kinki-Chuo Chest Medical Center, 1180 Nagasone-cho, Kita-ku, Sakai City, Osaka, 591-8555, Japan.
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16
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Walkoff L, Hobbs S. Chest Imaging in the Diagnosis of Occupational Lung Diseases. Clin Chest Med 2021; 41:581-603. [PMID: 33153681 DOI: 10.1016/j.ccm.2020.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Imaging plays a crucial role in the diagnosis and monitoring of occupational lung diseases (OLDs); however, the sensitivity and specificity of detection and diagnosis vary greatly depending on the imaging modality used. There is substantial overlap in appearance with non-occupation-related entities. OLDs should be considered in the differential even in the absence of a provided exposure history. Because many findings are not specific, a multidisciplinary approach is important in arriving at the diagnosis and will continue to be important as workplace-related pulmonary diseases evolve with changing industrial practices and workplace regulations.
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Affiliation(s)
- Lara Walkoff
- Divisions of Thoracic and Cardiovascular Radiology, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN 55905, USA.
| | - Stephen Hobbs
- Radiology Informatics and Integrated Clinical Operations, Division of Cardiovascular and Thoracic Radiology, UK HealthCare Imaging Informatics, University of Kentucky, 800 Rose Street, HX 302, Lexington, KY 40536, USA
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17
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Imaging in Occupational and Environmental Lung Disease. CURRENT PULMONOLOGY REPORTS 2020. [DOI: 10.1007/s13665-020-00250-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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18
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Lazzaro MC, Romanò S, Santoro S, Camuto C, Carbone A, Casamassima R, Abate S, De-Giorgio F. A potential cause of asbestos-related granulomatosis due to adulterant contamination in a drug abuser. Virchows Arch 2020; 478:361-366. [PMID: 32519036 DOI: 10.1007/s00428-020-02863-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 05/26/2020] [Accepted: 06/02/2020] [Indexed: 10/24/2022]
Abstract
Drug adulterants containing contaminants have been known to cause lung disease by inhalation or intravenous intake. Talcosis due to intravenous talc injection has been widely described in the literature, whereas the hypothesis of granulomatosis due to asbestos related to adulterated cocaine injection has not yet been explored. Herein, a case of pulmonary granulomatosis due to asbestos fibres related to cocaine injection in a young woman is described. Inorganic material in the lung was first individuated by light microscopy and last was identified using the SEM-EDX method. This case is unique since the occupational and passive inhalation of asbestos was excluded with absolute certainty.
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Affiliation(s)
- Maria Concetta Lazzaro
- Department of Health Care Surveillance and Bioetics, Section of Legal Medicine, Università Cattolica del Sacro Cuore, Rome, Italy.,Fondazione Policlinico Universitario A. Gemelli IRCCS, L. go F. Vito 1, 00168, Rome, Italy
| | - Sabrina Romanò
- Department of Health Care Surveillance and Bioetics, Section of Legal Medicine, Università Cattolica del Sacro Cuore, Rome, Italy.,Fondazione Policlinico Universitario A. Gemelli IRCCS, L. go F. Vito 1, 00168, Rome, Italy.,Reparto Carabinieri Investigazioni Scientifiche di Roma, Rome, Italy
| | - Sergio Santoro
- Department of Environmental Engineering, University of Calabria, Rende, Italy
| | - Cristian Camuto
- Department of Health Care Surveillance and Bioetics, Section of Legal Medicine, Università Cattolica del Sacro Cuore, Rome, Italy.,Fondazione Policlinico Universitario A. Gemelli IRCCS, L. go F. Vito 1, 00168, Rome, Italy
| | - Arnaldo Carbone
- Fondazione Policlinico Universitario A. Gemelli IRCCS, L. go F. Vito 1, 00168, Rome, Italy.,Area of Pathology, Department of Woman and Child Health and Public Health, Section of Morbid Pathology, Università Cattolica del Sacro Cuore, Rome, Italy
| | | | - Sergio Abate
- Reparto Carabinieri Investigazioni Scientifiche di Roma, Rome, Italy
| | - Fabio De-Giorgio
- Department of Health Care Surveillance and Bioetics, Section of Legal Medicine, Università Cattolica del Sacro Cuore, Rome, Italy. .,Fondazione Policlinico Universitario A. Gemelli IRCCS, L. go F. Vito 1, 00168, Rome, Italy.
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19
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Lin Y, Lu JY, Pinheiro-Neto CD, Jones DM, Gildener-Leapman N. Intranasal Acetaminophen Abuse and Nasal, Pharyngeal, and Laryngotracheal Damage. Cureus 2019; 11:e5432. [PMID: 31485385 PMCID: PMC6710488 DOI: 10.7759/cureus.5432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
A young adult female originally presented with necrosis of the nasal cavity mucosa and septum after sniffing crushed acetaminophen. She underwent endoscopic sinus surgery and debridement but continued to use acetaminophen intranasally. Four months later, the destruction had extended to include the posterior pharyngeal wall and subglottis. The diagnosis was confirmed by polarizable talc found on biopsy of the subglottis. While nasal insufflation of cocaine and hydrocodone-acetaminophen has been well-documented, intranasal abuse of exclusively acetaminophen is not well understood. This case demonstrates the destructive potential of intranasal acetaminophen use and may help physicians recognize unusual signs and symptoms of intranasal drug abuse.
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Affiliation(s)
- Yufan Lin
- Department of Surgery, Division of Otolaryngology, Albany Medical Center, Albany, USA
| | - Jennifer Y Lu
- Department of Surgery, Division of Otolaryngology, Albany Medical Center, Albany, USA
| | | | - David M Jones
- Department of Pathology, Albany Medical Center, Albany, USA
| | - Neil Gildener-Leapman
- Department of Surgery, Division of Otolaryngology, Albany Medical Center, Albany, USA
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20
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Scholtze D, Rueegg CA. Pulmonary talc granulomatosis mimicking lung cancer. BMJ Case Rep 2019; 12:12/4/e230180. [PMID: 30975791 DOI: 10.1136/bcr-2019-230180] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
- Dieter Scholtze
- Division of Pulmonary Medicine, Stadtspital Triemli, Zurich, Switzerland.,Department of Medicine, University of Zurich, Zurich, Switzerland
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21
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Khurana S, Chhoda A, Sahay S, Pathania P. Pulmonary foreign body granulomatosis in a chronic user of powder cocaine. ACTA ACUST UNITED AC 2018; 43:320-321. [PMID: 28792985 PMCID: PMC5687971 DOI: 10.1590/s1806-37562015000000269] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Accepted: 10/31/2016] [Indexed: 12/30/2022]
Abstract
We describe the case of a 33-year-old man, a chronic user of powder cocaine, who presented with dyspnea, fever, night sweats, and significant weight loss. Chest HRCT revealed centrilobular nodules, giving an initial impression of miliary tuberculosis. Therefore, he was started on an empirical, four-drug antituberculosis treatment regimen. Four weeks later, despite the tuberculosis treatment, he continued to have the same symptoms. We then performed transbronchial lung biopsy. Histopathological analysis of the biopsy sample revealed birefringent foreign body granuloma. A corroborative history of cocaine snorting, the presence of centrilobular nodules, and the foreign body-related histopathological findings led to a diagnosis of pulmonary foreign body granulomatosis. This report underscores the fact that pulmonary foreign body granulomatosis should be included in the differential diagnosis of clinical profiles resembling tuberculosis.
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Affiliation(s)
| | - Ankit Chhoda
- . Maulana Azad Medical College, Department of Internal Medicine, New Delhi, India
| | | | - Priyanka Pathania
- . Jack C. Montgomery VA Medical Center, Department of Pulmonary Medicine, Muskogee (OK) USA
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22
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McCabe BE, Veselis CA, Goykhman I, Hochhold J, Eisenberg D, Son H. Beyond Pulmonary Embolism; Nonthrombotic Pulmonary Embolism as Diagnostic Challenges. Curr Probl Diagn Radiol 2018; 48:387-392. [PMID: 30232041 DOI: 10.1067/j.cpradiol.2018.07.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Revised: 07/16/2018] [Accepted: 07/17/2018] [Indexed: 12/23/2022]
Abstract
Nonthrombotic pulmonary embolism (NTPE) is less well understood and is encountered less frequently than pulmonary embolism from venous thrombosis. NTPE results from embolization of nonthrombotic material to the pulmonary vasculature originating from many different cell types as well as nonbiologic or foreign materials. For many radiologists NTPE is a challenging diagnosis, presenting nonspecific or unusual imaging findings in the setting of few or unusual clinical signs. The aim of this paper is to review the pathophysiology of diverse causes of NTPE, which should aid radiologists to better understand and, more importantly, diagnose these infrequent events.
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Affiliation(s)
| | - Clinton A Veselis
- Temple University Hospital, Department of Radiology, Philadelphia, PA.
| | - Igor Goykhman
- Einstein Medical Center, Department of Radiology, Philadelphia, PA.
| | - John Hochhold
- Einstein Medical Center, Department of Radiology, Philadelphia, PA.
| | - Daniel Eisenberg
- Einstein Medical Center, Department of Radiology, Philadelphia, PA.
| | - Hongju Son
- Einstein Medical Center, Department of Radiology, Philadelphia, PA.
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23
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Cheema A, Chaughtai S, Mazahir U, Roy M, Hossain MA. An Unusual and Fatal Cause of Miliary Nodules on Chest Radiography. J Clin Med 2018; 7:jcm7070164. [PMID: 29966297 PMCID: PMC6068650 DOI: 10.3390/jcm7070164] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 06/25/2018] [Accepted: 06/25/2018] [Indexed: 11/21/2022] Open
Abstract
Foreign body granulomatosis has many etiologies, including the injection of oral medications intravenously. The insoluble filler materials that are used in the medications can lodge in pulmonary arterioles and capillaries, which can trigger foreign body giant cell reaction, chronic inflammation, thrombosis, and fibrosis, resulting in pulmonary hypertension, progressive shortness of breath, and, potentially, fatal conditions. On imaging, this may present with multiple miliary mottling’s/nodules. The use of a bronchoscopy with biopsy can be an excellent way to establish a diagnosis in appropriate clinical settings. Here, we present a case of a 37-year-old old male found to have multiple miliary densities on imaging due to intravenous use of oral medication.
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Affiliation(s)
- Anmol Cheema
- Department of Medicine, Jersey Shore University Medical Center, Hackensack Meridian Health, 1945 State Route 33, Neptune, NJ 07753, USA.
| | - Saira Chaughtai
- Department of Medicine, Jersey Shore University Medical Center, Hackensack Meridian Health, 1945 State Route 33, Neptune, NJ 07753, USA.
| | - Usman Mazahir
- Department of Medicine, Jersey Shore University Medical Center, Hackensack Meridian Health, 1945 State Route 33, Neptune, NJ 07753, USA.
| | - Manimala Roy
- Department of Pathology, Jersey Shore University Medical Center, Hackensack Meridian Health, 1945 State Route 33, Neptune, NJ 07753, USA.
| | - Mohammad A Hossain
- Department of Medicine, Jersey Shore University Medical Center, Hackensack Meridian Health, 1945 State Route 33, Neptune, NJ 07753, USA.
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24
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Unusual cause of a fatal foreign body pulmonary granulomatosis. Rechtsmedizin (Berl) 2018. [DOI: 10.1007/s00194-018-0253-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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25
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Abstract
The term nonthrombotic pulmonary embolism (NTPE) is defined as embolization of pulmonary arteries caused by foreign bodies (e. g. detached catheter fragments), biological substances (e. g. septic thrombus) or exogenous substances (e. g. gas). The frequency of NTPE is underestimated. Symptoms can cover the spectrum from undetectable to sudden death. In addition to mechanical obstruction of the pulmonary arteries, some NTPEs trigger an inflammatory cascade that causes deterioration of vascular, pulmonary and cardiac function. Radiological imaging in combination with the medical history of patients is sufficient to identify most NTPEs with certainty. The aim of this article is to make readers aware of the symptoms, frequency, relevance, classification, pathophysiology, laboratory findings and radiological findings of the most frequent forms of NTPE. The spectrum of forms presented here includes pulmonary embolisms due to foreign bodies (intravascular, intracorporeal and extracorporeal), amniotic fluid, endogenous tissue, fat, tumors, septic thrombi, hydatids, cement, metallic mercury, gas, silicone and particles.
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Affiliation(s)
- A G Bach
- Klinik für Diagnostische Radiologie, Martin-Luther-Universität Halle-Wittenberg, Ernst-Grube-Str. 40, 06120, Halle, Deutschland.
| | - D Schramm
- Klinik für Diagnostische Radiologie, Martin-Luther-Universität Halle-Wittenberg, Ernst-Grube-Str. 40, 06120, Halle, Deutschland
| | - A Surov
- Klinik für Diagnostische Radiologie, Universität Leipzig, Leipzig, Deutschland
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26
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Reverso-Meinietti J, Vandenbos F, Risso K, Coyne J, Leroy S, Padovani B, Burel-Vandenbos F. [Pulmonary intravascular talcosis: A case report]. Rev Med Interne 2018; 39:658-660. [PMID: 29650301 DOI: 10.1016/j.revmed.2018.03.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Revised: 02/22/2018] [Accepted: 03/09/2018] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Pulmonary intravascular talcosis is a rare condition occurring in intravenous drug users injecting oral medications. Talc results in a foreign-body granulomatous reaction giving a radiological haematogenic miliary appearance mimicking miliary tuberculosis. Drug users represent a population at risk for both these conditions and their distinction may be challenging. CASE REPORT We reported the case of a man, 33 year-old, intravenous drug addict, detected by the health services because he was the partner of a person who died of contagious and multi-resistant tuberculosis. Chest X-ray and CT scan showed a typical miliary appearance. Despite negative microbiology, clinical diagnosis of miliary tuberculosis was retained. Due to the lack of radiological improvement despite appropriate antibiotic treatment, re-evaluation and trans-bronchial biopsy were undertaken. The presence of granulomas centered by birefringent foreign bodies in polarized light led to a diagnosis of pulmonary intravascular talcosis. CONCLUSION In the presence of pulmonary miliary in an intravenous drug addict, intravascular talcosis should be suspected.
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Affiliation(s)
- J Reverso-Meinietti
- Laboratoire central d'anatomie pathologique, hôpital Pasteur, centre hospitalier universitaire de Nice, 30, voie Romaine, 06000 Nice, France
| | - F Vandenbos
- Centre de soins de suite et de rééducation cardiorespiratoire « La Maison du Mineur », 755, avenue Henri-Giraud, 06140 Vence, France
| | - K Risso
- Service de maladies infectieuses et tropicales, hôpital l'Archet I, centre hospitalier universitaire de Nice, 151, route de Saint-Antoine-de-Ginestière, 06200 Nice, France
| | - J Coyne
- Laboratoire central d'anatomie pathologique, hôpital Pasteur, centre hospitalier universitaire de Nice, 30, voie Romaine, 06000 Nice, France
| | - S Leroy
- Service de pneumologie, hôpital Pasteur, centre hospitalier universitaire de Nice, 30, voie romaine, 06000 Nice, France
| | - B Padovani
- Service de radiologie, hôpital Pasteur, centre hospitalier universitaire de Nice, 30, voie romaine, 06000 Nice, France
| | - F Burel-Vandenbos
- Laboratoire central d'anatomie pathologique, hôpital Pasteur, centre hospitalier universitaire de Nice, 30, voie Romaine, 06000 Nice, France.
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27
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Bercovici N, Russomanno K, Santoro F, Scola C, Murphy M, Elaba Z. Cutaneous refractile foreign body microemboli with intravascular injection of oral medication. J Cutan Pathol 2018; 45:365-368. [DOI: 10.1111/cup.13125] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2017] [Revised: 01/25/2018] [Accepted: 02/06/2018] [Indexed: 11/28/2022]
Affiliation(s)
| | - Kristen Russomanno
- Department of Dermatology, University of Connecticut School of Medicine; Farmington Connecticut
| | - Frank Santoro
- Department of Pathology; Hartford Hospital; Hartford Connecticut
| | | | - Michael Murphy
- Department of Dermatology, University of Connecticut School of Medicine; Farmington Connecticut
| | - Zendee Elaba
- Department of Pathology; Hartford Hospital; Hartford Connecticut
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29
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Morrison DA, Wise SK, DelGaudio JM, Chowdhury NI, Levy JM. Intranasal tissue necrosis associated with opioid abuse: Case report and systematic review. Laryngoscope 2017; 128:1767-1771. [PMID: 29280484 DOI: 10.1002/lary.27069] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/27/2017] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Opioid abuse is a common disorder affecting over 2 million Americans. Intranasal tissue necrosis is a previously described sequela of nasal opioid inhalation, with a similar presentation to invasive fungal rhinosinusitis (IFRS). The goal of this case report and systematic review is to evaluate the evidence supporting this uncommon disease, with qualitative analysis of the presentation, management and treatment outcomes. DATA SOURCES MEDLINE, EMBASE, Google Scholar, Scopus, and Web of Science. REVIEW METHODS Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines were utilized to identify English-language studies reporting intranasal mucosal injury associated with prescription opioid abuse. Primary outcomes included clinical presentation, treatment strategies, and outcomes. RESULTS Systematic review identified 61 patients for qualitative analysis. Common clinical features include facial pain without a history of chronic sinusitis or known immunodeficiency. Diagnostic nasal endoscopy revealed superficial debris with underlying tissue necrosis, consistent with a preliminary diagnosis of IFRS. Characteristic pathologic findings include mucosal ulceration with an overlying acellular substrate, often with polarizable material. Fungal colonization is often reported, with several accounts of angiocentric invasion in immunocompetent patients. Complete symptom resolution is expected following surgical debridement with cessation of intranasal opioid inhalation, with 89% of identified patients experiencing a complete resolution of disease. CONCLUSION Intranasal opioid abuse is a prevalent condition associated with chronic pain and tissue necrosis that is clinically concerning for invasive fungal disease. Whereas IFRS must be excluded, even in patients without known immunodeficiency, complete resolution of symptoms can be expected following surgical debridement with cessation of opioid abuse. Laryngoscope, 1767-1771, 2018.
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Affiliation(s)
| | - Sarah K Wise
- Department of Otolaryngology-Head and Neck Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - John M DelGaudio
- Department of Otolaryngology-Head and Neck Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - Naweed I Chowdhury
- Department of Otolaryngology and Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, U.S.A
| | - Joshua M Levy
- Department of Otolaryngology-Head and Neck Surgery, Emory University School of Medicine, Atlanta, Georgia
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30
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Escuissato DL, Ferreira RG, Barros JAD, Marchiori E. Pulmonary talcosis caused by intravenous methadone injection. J Bras Pneumol 2017; 43:154-155. [PMID: 28538785 PMCID: PMC5474381 DOI: 10.1590/s1806-37562016000000337] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
| | | | | | - Edson Marchiori
- . Universidade Federal do Rio de Janeiro. Rio de Janeiro (RJ) Brasil
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31
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Jasuja S, Kuhn BT, Schivo M, Adams JY. Cosmetic Talc-Related Pulmonary Granulomatosis. J Investig Med High Impact Case Rep 2017; 5:2324709617728527. [PMID: 28959693 PMCID: PMC5593219 DOI: 10.1177/2324709617728527] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Revised: 07/15/2017] [Accepted: 07/21/2017] [Indexed: 11/15/2022] Open
Abstract
Inhalation of cosmetic talc can lead to pulmonary foreign-body granulomatosis, though fewer than 10 cases of inhaled cosmetic talc–related pulmonary granulomatosis have been reported in adults. We report the case of a 64-year-old man with diffuse, bilateral pulmonary nodules and ground glass opacities associated with chronic inhalation of cosmetic talc. Transbronchial biopsy showed peribronchiolar foreign-body granulomas. After cessation of talc exposure, the patient demonstrated clinical and radiographic improvement without the use of corticosteroids. This case demonstrates that a conservative approach with cessation of exposure alone, without the use of corticosteroids, can be an effective therapy in cosmetic talc–related pulmonary granulomatosis.
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Affiliation(s)
- Sonia Jasuja
- University California Davis Medical Center, Sacramento, CA, USA
| | - Brooks T. Kuhn
- University California Davis Medical Center, Sacramento, CA, USA
| | - Michael Schivo
- University California Davis Medical Center, Sacramento, CA, USA
- University of California Davis, CA, USA
| | - Jason Y. Adams
- University California Davis Medical Center, Sacramento, CA, USA
- University of California Davis, CA, USA
- Jason Y. Adams, MD, MS, Division of Pulmonary, Critical Care, and Sleep Medicine, University of California Davis School of Medicine, 4150 V Street, Ste 3400, Sacramento, CA 95817, USA.
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32
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Nonthrombotic Pulmonary Artery Embolism: Imaging Findings and Review of the Literature. AJR Am J Roentgenol 2017; 208:505-516. [DOI: 10.2214/ajr.16.17326] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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Matrosovich E, Brodmann R, Lampert S, Lehnert G, Hartmann A, Ficker J. Dyspnea following intravenous drug use. Respir Med Case Rep 2017; 20:192-194. [PMID: 28316931 PMCID: PMC5344321 DOI: 10.1016/j.rmcr.2017.02.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Revised: 02/02/2017] [Accepted: 02/03/2017] [Indexed: 11/24/2022] Open
Affiliation(s)
- E. Matrosovich
- Department of Respiratory Medicine, Allergology and Sleep Medicine, Nuremberg General Hospital, Nuremberg, Germany
- Paracelsus Medical University, Nuremberg, Germany
- Corresponding author. Department of Respiratory Medicine, Allergology, Sleep Medicine, Nuremberg General Hospital/Paracelsus Medical University, Prof.-Ernst-Nathan Str.1, 90419 Nuremberg, Germany.Department of Respiratory Medicine, Allergology, Sleep MedicineNuremberg General Hospital/Paracelsus Medical UniversityProf.-Ernst-Nathan Str.1Nuremberg90419Germany
| | - R. Brodmann
- Department of Respiratory Medicine, Allergology and Sleep Medicine, Nuremberg General Hospital, Nuremberg, Germany
- Paracelsus Medical University, Nuremberg, Germany
| | - S. Lampert
- Respiratory Medical Practice, Uttenreuth, Germany
| | - G. Lehnert
- Respiratory Medical Practice, Uttenreuth, Germany
| | - A. Hartmann
- Institute of Pathology, Friedrich-Alexander-University of Erlangen-Nuremberg, Germany
| | - J.H. Ficker
- Department of Respiratory Medicine, Allergology and Sleep Medicine, Nuremberg General Hospital, Nuremberg, Germany
- Paracelsus Medical University, Nuremberg, Germany
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Anderson RJ, Corbett B, Ly BT. A Case of Acute Pericarditis Following Intravenous Injection of Crushed Morphine Tablets. J Psychoactive Drugs 2016; 48:355-358. [PMID: 27767408 DOI: 10.1080/02791072.2016.1242028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
A 37-year-old male presented with sharp, severe chest pain following seven days of intravenous injection of crushed morphine tablets. The chest pain was positional and pleuritic in nature and resolved with leaning forward. Work-up was notable for an ECG with inferior and anterolateral PR depressions as well as a CT chest with diffuse centrilobular nodules. Per radiology, the CT findings along with the patient's history were concerning for pulmonary granulomatosis from deposition of talc or some other foreign body. Cardiology was consulted and diagnosed the patient with acute pericarditis, given his typical symptoms and ECG changes. On review of the literature, pulmonary granulomatosis following intravenous injection of foreign bodies is well documented. There are numerous studies documenting foreign body deposition and granulomatosis in organs other than the lungs on post-mortem analyses of individuals with a history of IV injection of crushed tablets. We are suggesting that intravenous injection of crushed morphine tablets can cause pericardial irritation and a syndrome of acuter pericarditis. To our knowledge, there has not been a previous report of acute pericarditis secondary to intravenous injection of crushed tablets.
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Affiliation(s)
- Ryan J Anderson
- a Internal Medicine Resident, Department of Internal Medicine , University of California San Diego , San Diego , CA , USA
| | - Bryan Corbett
- b Toxicology Fellow, Division of Medical Toxicology, Department of Emergency Medicine , University of California San Diego , San Diego , CA , USA
| | - Binh T Ly
- c Professor of Emergency Medicine, Division of Medical Toxicology, Department of Emergency Medicine , University of California San Diego , San Diego , CA , USA
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Rai S, Acharya V, Vahab S, Minal J, Chakraborti S. "Bright asteroids in the polar sky"-clinic-radio-pathological correlation in an unusual case of silicotuberculosis. Indian J Occup Environ Med 2016; 20:60-3. [PMID: 27390482 PMCID: PMC4922280 DOI: 10.4103/0019-5278.183847] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
We present a case of acute silicosis presenting with severe breathlessness and respiratory failure. An unusual aspect in our case was the presence of acute silicosis with respiratory failure in backdrop of long-term silica exposure. The other striking aspect in this case was the demonstration of crystalline silica particles under polarizing light in bronchial lavage fluid sample and coexistence of tuberculosis with acute silicosis.
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Affiliation(s)
- Santosh Rai
- Department of Radiology, Kasturba Medical College and Hospital, Mangaluru, Karnataka, India
| | - Vishak Acharya
- Department of Pulmonary Medicine, Kasturba Medical College and Hospital, Mangaluru, Karnataka, India
| | - Sanoj Vahab
- Department of Internal Medicine, Kasturba Medical College and Hospital, Mangaluru, Karnataka, India
| | - Jessica Minal
- Department of Pathology, Kasturba Medical College and Hospital, Mangaluru, Karnataka, India
| | - Shrijeet Chakraborti
- Department of Pathology, Kasturba Medical College and Hospital, Mangaluru, Karnataka, India
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Pulmonary Talcosis in an Immunocompromised Patient. Case Rep Med 2016; 2016:4678637. [PMID: 27446215 PMCID: PMC4944058 DOI: 10.1155/2016/4678637] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Accepted: 06/12/2016] [Indexed: 11/18/2022] Open
Abstract
The first case of pulmonary talcosis or talc pneumoconiosis related to inhalation of talc during its extraction and processing in mines was described by Thorel in 1896. Pulmonary talcosis is most commonly seen secondary to occupational exposure or intravenous (IV) drug abuse and, occasionally, in excessive use of cosmetic talc. Based on literature review, there has been an increase in reported incidents of pulmonary talcosis due to various forms of exposure to the mineral. We report an 82-year-old man who is diagnosed with Philadelphia chromosome positive pre-B cell acute lymphoblastic leukemia (ALL) treated with palliative imatinib who presented with chronic hemoptysis and dyspnea shortly after his diagnosis. His symptoms were initially thought to be due to an infectious etiology due to his malignancy, immunocompromised state, and radiographic findings until high-resolution computerized tomographic (HRCT) findings showed a diffuse pulmonary fibrosis picture that prompted further questioning and a more thorough history inquiry on his exposure to causative agents of interstitial lung disease. Very often, patients do not recognize their exposure, especially in those whose exposure is unrelated to their occupation. Our case emphasizes the need for thorough and careful history taking of occupational and nonoccupational exposure to known causative agents of interstitial lung disease.
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Almeida RRD, Zanetti G, Souza AS, Souza LSD, Silva JLPE, Escuissato DL, Irion KL, Mançano AD, Nobre LF, Hochhegger B, Marchiori E. Cocaine-induced pulmonary changes: HRCT findings. J Bras Pneumol 2016; 41:323-30. [PMID: 26398752 PMCID: PMC4635952 DOI: 10.1590/s1806-37132015000000025] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Objective: To evaluate HRCT scans of the chest in 22 patients with cocaine-induced pulmonary disease. Methods: We included patients between 19 and 52 years of age. The HRCT scans were evaluated by two radiologists independently, discordant results being resolved by consensus. The inclusion criterion was an HRCT scan showing abnormalities that were temporally related to cocaine use, with no other apparent causal factors. Results: In 8 patients (36.4%), the clinical and tomographic findings were consistent with "crack lung", those cases being studied separately. The major HRCT findings in that subgroup of patients included ground-glass opacities, in 100% of the cases; consolidations, in 50%; and the halo sign, in 25%. In 12.5% of the cases, smooth septal thickening, paraseptal emphysema, centrilobular nodules, and the tree-in-bud pattern were identified. Among the remaining 14 patients (63.6%), barotrauma was identified in 3 cases, presenting as pneumomediastinum, pneumothorax, and hemopneumothorax, respectively. Talcosis, characterized as perihilar conglomerate masses, architectural distortion, and emphysema, was diagnosed in 3 patients. Other patterns were found less frequently: organizing pneumonia and bullous emphysema, in 2 patients each; and pulmonary infarction, septic embolism, eosinophilic pneumonia, and cardiogenic pulmonary edema, in 1 patient each. Conclusions: Pulmonary changes induced by cocaine use are varied and nonspecific. The diagnostic suspicion of cocaine-induced pulmonary disease depends, in most of the cases, on a careful drawing of correlations between clinical and radiological findings.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Bruno Hochhegger
- Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, BR
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Macrophage and Multinucleated Giant Cell Classification. CURRENT TOPICS IN ENVIRONMENTAL HEALTH AND PREVENTIVE MEDICINE 2016. [DOI: 10.1007/978-4-431-55732-6_1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Gasior M, Bond M, Malamut R. Routes of abuse of prescription opioid analgesics: a review and assessment of the potential impact of abuse-deterrent formulations. Postgrad Med 2015; 128:85-96. [DOI: 10.1080/00325481.2016.1120642] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Shim I, Kim HM, Yang S, Choi M, Seo GB, Lee BW, Yoon BI, Kim P, Choi K. Inhalation of Talc Induces Infiltration of Macrophages and Upregulation of Manganese Superoxide Dismutase in Rats. Int J Toxicol 2015; 34:491-9. [PMID: 26482432 DOI: 10.1177/1091581815607068] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Talc is a mineral that is widely used in cosmetic products, antiseptics, paints, and rubber manufacturing. Although the toxicological effects of talc have been studied extensively, until now no detailed inhalation study of talc focusing on oxidative stress has been done. This repeated 4 weeks whole-body inhalation toxicity study of talc involved Sprague-Dawley rats. Male and female groups of rats were exposed to inhaled talc at 0, 5, 50, and 100 mg/m(3) for 6 hours daily, 5 days/week for 4 weeks. The objective was to identify the 4-week inhalation toxicity of talc and investigate antioxidant activity after exposure to talc. There were no treatment-related symptoms or mortality in rats treated with talc. Glucose (GLU) was decreased significantly in male rats exposed to 50 and 100 mg/m(3) of talc. Histopathological examination revealed infiltration of macrophages on the alveolar walls and spaces near the terminal and respiratory bronchioles. In male and female rats exposed to 100 mg/m(3) talc, expression of superoxide dismutase 2, a typical biological indicator of oxidative damage, was significantly increased. Thus, inhalation of talc induces macrophage aggregations and oxidative damage in the lung.
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Affiliation(s)
- Ilseob Shim
- Department of Environmental Health Research, National Institute of Environmental Research, Incheon, Republic of Korea
| | - Hyun-Mi Kim
- Department of Environmental Health Research, National Institute of Environmental Research, Incheon, Republic of Korea
| | - Sangyoung Yang
- Department of Environmental Health Research, National Institute of Environmental Research, Incheon, Republic of Korea
| | - Min Choi
- Department of Environmental Health Research, National Institute of Environmental Research, Incheon, Republic of Korea
| | - Gyun-Baek Seo
- Department of Environmental Health Research, National Institute of Environmental Research, Incheon, Republic of Korea
| | - Byung-Woo Lee
- College of Veterinary Medicine and Institute of Veterinary Science, Kangwon National University, Chuncheon, Republic of Korea
| | - Byung-Il Yoon
- College of Veterinary Medicine and Institute of Veterinary Science, Kangwon National University, Chuncheon, Republic of Korea
| | - Pilje Kim
- Department of Environmental Health Research, National Institute of Environmental Research, Incheon, Republic of Korea
| | - Kyunghee Choi
- Department of Environmental Health Research, National Institute of Environmental Research, Incheon, Republic of Korea
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41
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Lee JH, Lee KB. Alternative antireflection substance for a digital impression. J Prosthet Dent 2015; 114:460-1. [DOI: 10.1016/j.prosdent.2015.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Revised: 04/14/2015] [Accepted: 04/14/2015] [Indexed: 10/23/2022]
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Francisco FAF, Rodrigues RS, Barreto MM, Escuissato DL, Araujo Neto CA, Silva JLPE, Silva CS, Hochhegger B, Souza Jr. AS, Zanetti G, Marchiori E. Can chest high-resolution computed tomography findings diagnose pulmonary alveolar microlithiasis? Radiol Bras 2015; 48:205-10. [PMID: 26379317 PMCID: PMC4567357 DOI: 10.1590/0100-3984.2014.0123] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Accepted: 02/13/2015] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE The present study was aimed at retrospectively reviewing high-resolution computed tomography (HRCT) findings in patients with pulmonary alveolar microlithiasis in order to evaluate the frequency of tomographic findings and their distribution in the lung parenchyma. MATERIALS AND METHODS Thirteen patients (9 females and 4 males; age, 9 to 59 years; mean age, 34.5 years) were included in the present study. The HRCT images were independently evaluated by two observers whose decisions were made by consensus. The inclusion criterion was the presence of abnormalities typical of pulmonary alveolar microlithiasis at HRCT, which precludes lung biopsy. However, in 6 cases lung biopsy was performed. RESULTS Ground-glass opacities and small parenchymal nodules were the predominant tomographic findings, present in 100% of cases, followed by small subpleural nodules (92.3%), subpleural cysts (84.6%), subpleural linear calcifications (69.2%), crazy-paving pattern (69.2%), fissure nodularity (53.8%), calcification along interlobular septa (46.2%) and dense consolidation (46.2%). CONCLUSION As regards distribution of the lesions, there was preferential involvement of the lower third of the lungs. No predominance of distribution in axial and anteroposterior directions was observed.
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Affiliation(s)
| | - Rosana Souza Rodrigues
- PhD, Professor, Program of Post-graduation in Radiology,
Universidade Federal do Rio de Janeiro (UFRJ), Physician at the Service of Radiology,
Hospital Universitário Clementino Fraga Filho da Universidade Federal do Rio de Janeiro
(UFRJ) and Instituto D’Or de Pesquisa e Educação, Rio de Janeiro, RJ, Brazil
| | - Miriam Menna Barreto
- PhD, Professor, Program of Post-graduation in Radiology,
Universidade Federal do Rio de Janeiro (UFRJ), Physician at the Service of Radiology,
Hospital Universitário Clementino Fraga Filho da Universidade Federal do Rio de Janeiro
(UFRJ), Rio de Janeiro, RJ, Brazil
| | - Dante Luiz Escuissato
- PhD, Associate Professor of Radiology, Department of
Medical Practice, Universidade Federal do Paraná (UFPR), Curitiba, PR, Brazil
| | - Cesar Augusto Araujo Neto
- PhDs, Associate Professors, Department of Medicine and
Diagnostic Support, Universidade Federal da Bahia (UFBA), Salvador, BA, Brazil
| | - Jorge Luiz Pereira e Silva
- PhDs, Associate Professors, Department of Medicine and
Diagnostic Support, Universidade Federal da Bahia (UFBA), Salvador, BA, Brazil
| | - Claudio S. Silva
- MD, Radiology Department, Facultad de Medicina Clinica
Alemana, Universidad del Desarrollo Santiago, Chile
| | - Bruno Hochhegger
- PhD, Associate Professor of Imaging Diagnosis, Universidade
Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil
| | - Arthur Soares Souza Jr.
- PhD, Professor, Faculdade de Medicina de São José do Rio
Preto (Famerp), São José do Rio Preto, SP, Brazil
| | - Gláucia Zanetti
- PhD, Professor, Program of Post-graduation in Radiology at
Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, Professor of Medical
Practice, Faculdade de Medicina de Petrópolis, Petrópolis, RJ, Brazil
| | - Edson Marchiori
- PhD, Full Professor Emeritus, Universidade Federal
Fluminense (UFF), Niterói, RJ, Associate Professor, Universidade Federal do Rio de
Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
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43
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Weissman DN. Role of chest computed tomography in prevention of occupational respiratory disease: review of recent literature. Semin Respir Crit Care Med 2015; 36:433-48. [PMID: 26024350 DOI: 10.1055/s-0035-1547348] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
This review provides an update on literature published over the past 5 years that is relevant to using chest computed tomography (CT) as a tool for preventing occupational respiratory disease. An important area of investigation has been in the use of low-dose CT (LDCT) to screen asbestos-exposed populations for lung cancer. Two recent systematic reviews have reached conclusions in support of screening. Based on the limited evidence that is currently available, the Finnish Institute of Occupational Health has recommended LDCT screening in asbestos-exposed individuals if their personal combination of risk factors yields a risk for lung cancer equal to that needed for entry into the National Lung Screening Trial. It has also recommended further research, such as to document the optimal frequency of screening and the effectiveness of screening. Recent literature continues to support high-resolution CT (HRCT) as being more sensitive than chest radiography in detecting pneumoconiosis. However, there are insufficient data to determine the effectiveness of HRCT screening in improving individual outcomes if used in screening for pneumoconiosis and its routine use for this purpose cannot be recommended. However, if HRCT is used to evaluate populations, recent literature shows that the International Classification of HRCT for Occupational and Environmental Respiratory Diseases provides an important tool for reproducible evaluation and recording of findings. HRCT is an important tool for individual patient management and recent literature has documented that chest HRCT findings are significantly associated with outcomes such as pulmonary function and mortality.
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Affiliation(s)
- David N Weissman
- Division of Respiratory Disease Studies, National Institute for Occupational Safety and Health, Morgantown, West Virginia
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44
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Affiliation(s)
- Bruno Hochhegger
- Medical Imaging Research Laboratory of Universidade Federal de Ciências da Saúde de Porto Alegre and Santa Casa de Porto Alegre, Porto Alegre, RS, Brazil
| | | | | | - Adalberto Sperb Rubin
- Medical Imaging Research Laboratory of Universidade Federal de Ciências da Saúde de Porto Alegre and Santa Casa de Porto Alegre, Porto Alegre, RS, Brazil
| | - Gláucia Zanetti
- Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
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Pulmonary effects of i.v. injection of crushed oral tablets: "excipient lung disease". AJR Am J Roentgenol 2015; 203:W506-15. [PMID: 25341165 DOI: 10.2214/ajr.14.12582] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE When crushed oral tablets are injected i.v., their filler material (excipient) can induce a potentially fatal foreign-body reaction in pulmonary arterioles, presenting as dyspnea and pulmonary hypertension with centrilobular nodules on CT. We will describe the imaging and pathologic features of "excipient lung disease." CONCLUSION The radiologist has a critical role in recognizing and reporting excipient lung disease because the referring clinician may be unaware of the patient's i.v. drug abuse.
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46
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Rupf S, Berger H, Buchter A, Harth V, Ong MF, Hannig M. Exposure of patient and dental staff to fine and ultrafine particles from scanning spray. Clin Oral Investig 2014; 19:823-30. [DOI: 10.1007/s00784-014-1300-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2012] [Accepted: 07/29/2014] [Indexed: 01/12/2023]
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47
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Altraja A, Jürgenson K, Roosipuu R, Laisaar T. Pulmonary intravascular talcosis mimicking miliary tuberculosis in an intravenous drug addict. BMJ Case Rep 2014; 2014:bcr-2014-203908. [PMID: 24713715 DOI: 10.1136/bcr-2014-203908] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Pulmonary foreign body granulomatosis following intravenous administration of medications meant for oral use among drug addicts has been occasionally reported. This condition is often misdiagnosed because of its rarity, but rather due to its similarity to other pulmonary diseases that are more common. Here we report a case of pulmonary intravascular talcosis mimicking miliary tuberculosis in a young male intravenous drug addict from North-Eastern Estonia, known as a hotspot for tuberculosis and drug misuse. The condition was caused by intravenous administration of crushed tablets of diphenhydramine, but miliary tuberculosis was misdiagnosed on patient's demographical, clinical and radiological grounds and a decision to start treatment with four first-line antituberculosis drugs followed. The current report refers to the importance of considering rare causes of pulmonary disseminations with attempts to identify the causative agent and warns against the use of antituberculosis treatment without confirmation of microbiological diagnosis of tuberculosis.
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Affiliation(s)
- Alan Altraja
- Department of Pulmonary Medicine, University of Tartu, Tartu, Estonia
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48
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de Almeida RR, de Souza LS, Mançano AD, Souza AS, Irion KL, Nobre LF, Zanetti G, Hochhegger B, Pereira e Silva JL, Marchiori E. High-Resolution Computed Tomographic Findings of Cocaine-Induced Pulmonary Disease: A State of the Art Review. Lung 2014; 192:225-33. [DOI: 10.1007/s00408-013-9553-6] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2013] [Accepted: 12/30/2013] [Indexed: 10/25/2022]
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49
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Bastawrous S, Hirschmann JV. A Man in His Early 70s With Progressive Dyspnea and Abnormal Fundoscopic Examination. Chest 2014; 145:178-181. [DOI: 10.1378/chest.13-1277] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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50
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Arboe DK, Tomashefski JF. Pulmonary Foreign Body Embolism and Granulomatosis in Intravenous Substance Abuse. Acad Forensic Pathol 2013. [DOI: 10.23907/2013.048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Prescription drug abuse has increased in the United States in part because of the relative ease of acquisition. Some drug abusers resort to the injection of crushed tablets for rapid onset and increased euphoria. Adolescents and young adults with chronic pain disorders and intravenous access ports are particularly susceptible to this practice. Clinically, those who inject tablets may develop dyspnea, hypoxemia, pulmonary hypertension, and are at an increased risk of sudden death. In addition to the active ingredient(s), pharmaceutical tablets contain inert excipients such as talc, starch, microcrystalline cellulose and crospovidone. Angiothrombosis and foreign body granulomatosis induced by particulate emboli are the major pathological findings identified. Tablet excipients can be discerned by their morphological and histochemical attributes. Microanalytic techniques may be required for definitive identification. Inhalational exposures, aspiration, endogenously formed crystals, and hyperalimentation are potential mimickers of tablet-induced foreign body emboli and granulomatosis.
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Affiliation(s)
- David K. Arboe
- Case Western Reserve University School of Medicine in Cleveland, OH
- MetroHealth Medical Center and Case Western Reserve University School of Medicine - Pathology, Cleveland, OH (JT)
| | - Joseph F. Tomashefski
- MetroHealth Medical Center and Case Western Reserve University School of Medicine - Pathology, Cleveland, OH (JT)
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