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Roset-Altadill A, Wat D, Radike M. Cardiovascular and pulmonary complications of recreational drugs: A pictorial review. Eur J Radiol 2024; 178:111648. [PMID: 39089058 DOI: 10.1016/j.ejrad.2024.111648] [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: 03/20/2024] [Revised: 07/12/2024] [Accepted: 07/22/2024] [Indexed: 08/03/2024]
Abstract
Recreational drug abuse constitutes a serious health problem worldwide. Consumption of cocaine, amphetamine-type stimulants, opioids and cannabis can lead to multiple acute and chronic cardiopulmonary complications, resulting in high morbidity and mortality. These complications may be first detected at imaging, since clinical presentation is usually non-specific. Cardiovascular complications include myocardial infarction, endocarditis, aortic dissection, infectious pseudoaneurysm, retained needle fragments, cardiomyopathy and pulmonary arterial hypertension. Pulmonary complications encompass pulmonary oedema, crack lung, pneumonia, septic emboli, barotrauma, airway disease, emphysema and excipient lung disease. Knowledge of the cardiopulmonary imaging manifestations of illicit drug use in conjunction with clinical history and a high grade of suspicion enable an accurate diagnosis and appropriate management plan. In this article we aim to provide a pictorial review of the most frequent cardiopulmonary manifestations of recreational drugs, emphasizing the underlying pathophysiologic mechanisms and the various imaging appearances.
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Affiliation(s)
- Adria Roset-Altadill
- Institut de Diagnòstic per la Imatge, Hospital Universitari de Girona Doctor Josep Trueta, Avinguda de França S/N, 17007, Girona, Spain.
| | - Dennis Wat
- Respiratory Medicine Department, Liverpool Heart and Chest Hospital, Thomas Drive, Liverpool L14 3PE, United Kingdom.
| | - Monika Radike
- Radiology Department, Liverpool Heart and Chest Hospital, Thomas Drive, Liverpool L14 3PE, United Kingdom; Cardiovascular Research Center-ICCC, IIB-Sant Pau, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.
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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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Giancaspro G, Kligerman SJ. Excipient Lung Disease in a Patient with Preexisting Chronic Thromboembolic Disease. Radiol Cardiothorac Imaging 2023; 5:e230059. [PMID: 37693202 PMCID: PMC10483241 DOI: 10.1148/ryct.230059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 04/16/2023] [Accepted: 05/22/2023] [Indexed: 09/12/2023]
Abstract
Excipient lung disease is an uncommon condition that occurs when crushed oral tablets are injected intravenously and cause pulmonary hypertension. Diagnosis requires a high degree of clinical suspicion and recognition of characteristic imaging findings. The authors present a previously unreported combination of findings in a patient with excipient lung disease and preexisting chronic thromboembolic disease. A pattern of diffuse centrilobular nodules with sparing of lung segments with chronically occluded pulmonary arteries was highly suggestive of the diagnosis and indicated a vascular cause. Pathologic specimen obtained at the time of pulmonary thromboendarterectomy helped confirm the clinically suspected entity. Keywords: Pulmonary Arteries, Embolism/Thrombosis, Foreign Bodies, Lung Supplemental material is available for this article. © RSNA, 2023.
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Affiliation(s)
- Gianni Giancaspro
- From the Department of Radiology, Jewish General Hospital, 3755 ch de
la Côte-Sainte-Catherine, Montreal, QC, Canada H3T 1E2 (G.G.); and
Department of Radiology, National Jewish Health, Denver, Colo (S.J.K.)
| | - Seth J. Kligerman
- From the Department of Radiology, Jewish General Hospital, 3755 ch de
la Côte-Sainte-Catherine, Montreal, QC, Canada H3T 1E2 (G.G.); and
Department of Radiology, National Jewish Health, Denver, Colo (S.J.K.)
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4
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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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5
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Colbenson GA, Kubbara A, Cox CW, Yi ES, Baqir M. Excipient lung disease secondary to intravenous heroin use. BMJ Case Rep 2022; 15:e247763. [PMID: 35450874 PMCID: PMC9024198 DOI: 10.1136/bcr-2021-247763] [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] [Accepted: 03/29/2022] [Indexed: 11/03/2022] Open
Abstract
We present a case of a woman who had progressive shortness of breath and wheezing with a mild restrictive pulmonary function pattern. She was initially diagnosed with eosinophilic granulomatosis with polyangiitis on the basis of peripheral eosinophilia, bronchoalveolar lavage eosinophilia (47%) and surgical lung biopsy findings. Six months following her diagnosis, the patient returned because of persistent symptoms, and a second review of the lung biopsy revealed thrombotic lesions in the pulmonary vessels with polarisable foreign body materials, associated giant cell reactions and numerous eosinophil infiltrates, consistent with intravenous drug abuse. Further investigation showed that she had a history of intravenous heroin overdose, and the diagnosis of excipient lung disease was made. This case highlights the importance of expert pathological, radiological and clinical review of complex presentations and the need for a thorough medication and drug use history review.
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Affiliation(s)
| | - Aahd Kubbara
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Christian W Cox
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Eunhee S Yi
- Division of Anatomic Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Misbah Baqir
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota, USA
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6
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Hossein-Zadeh Z, Shuman MJ, Rapkiewicz A. Fatal Excipients: An Autopsy Case Series of Excipient Lung Disease. Am J Forensic Med Pathol 2022; 43:81-89. [PMID: 34510050 DOI: 10.1097/paf.0000000000000721] [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: 11/27/2022]
Abstract
ABSTRACT Crushed oral tablets, when injected intravenously, may induce a foreign body granulomatous reaction in and around pulmonary arterioles, because of the presence of filler materials (excipients). This typically presents as shortness of breath in the context of pulmonary hypertension with arteriolar dilation and centrilobular nodules on imaging modalities. The constellation of findings may be overlooked or misdiagnosed by clinicians and pathologists, ultimately affecting patient care and postmortem assessment. We describe 5 patients with excipient lung disease that had antemortem chronic medical conditions that required a peripherally inserted catheter or port. All 5 patients had intravascular and perivascular deposition of polarizable foreign material within the pulmonary arteries. Foreign body granulomatosis as a result of intravenous drug use was not clinically suspected in any patient, and 2 of the 5 patients were misdiagnosed with mycobacterium infections. Pulmonary congestion, dyspnea, and symptoms of heart failure were noted in 3 patients and 2 had a history of upper arm deep vein thrombosis. We conclude that excipient lung disease may be underdiagnosed cause of dyspnea, pulmonary hypertension, and death in patients with a known history of intravenous drug use.
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Affiliation(s)
- Zarrin Hossein-Zadeh
- From the Department of Pathology, NYU Langone Health, Long Island School of Medicine, Mineola, NY
| | - Mark J Shuman
- Miami-Dade County Medical Examiner Department, Miami, FL
| | - Amy Rapkiewicz
- From the Department of Pathology, NYU Langone Health, Long Island School of Medicine, Mineola, NY
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7
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Systemic AA Amyloidosis Associated With Intravenous Injection of Oral Prescription Opioids-An Autopsy Case Report. Am J Forensic Med Pathol 2021; 43:191-194. [PMID: 34510052 PMCID: PMC9076248 DOI: 10.1097/paf.0000000000000718] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
There are reports of AA amyloidosis associated with intravenous and/or subcutaneous injection of street drugs, such as heroin and cocaine. Most reports describe patients with substance use disorder, renal amyloidosis and concurrent viral infections, such as hepatitis and/or human immunodeficiency virus. Herein, we present a case of systemic AA amyloidosis and sepsis in a 34-year-old woman with a history of intravenous injection of oral prescription medications (as evidenced by excipient lung disease) who had no known history of human immunodeficiency virus nor of hepatitis B or C. Our case shows the broader spectrum of pathology that can occur with the misuse of prescription medications.
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8
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Cook CM, Simpson SQ, Satterwhite L. Excipient-Induced Pulmonary Vascular Disease: An Underrecognized and Deadly Complication of Opioid Addiction. Lung 2021; 199:363-368. [PMID: 34313827 DOI: 10.1007/s00408-021-00456-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 07/09/2021] [Indexed: 11/27/2022]
Abstract
Despite widespread public health concern regarding opioid misuse and overuse, there is a paucity of literature on the acute and chronic pulmonary vascular and cardiac implications of excipient lung disease. This case series describes the clinical presentation of five adult patients who experienced profound pulmonary hypertension and right heart failure in the setting of confirmed or suspected crushed opioid injection at a single academic center between 2012 and 2019. The clinical characteristics and right heart catheterization data presented in these cases demonstrate the acute intravascular effects of the intravenous injection of crushed opioids and potential for hemodynamic collapse. Moreover, these cases suggest that survivors of acute excipient lung disease may develop chronic pulmonary vascular disease. Further studies are needed to explore the epidemiology and outcomes of oral opioid-induced intravascular excipient lung disease to increase awareness of this life-threatening complication among health care professionals and guide treatment and prevention measures.
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Affiliation(s)
- Christine M Cook
- Division of Pulmonary, Critical Care, & Sleep Medicine, University of Kansas School of Medicine, 3901 Rainbow Boulevard, Mail Stop #3007, Kansas City, KS, 66160-7381, USA
| | - Steven Q Simpson
- Division of Pulmonary, Critical Care, & Sleep Medicine, University of Kansas School of Medicine, 3901 Rainbow Boulevard, Mail Stop #3007, Kansas City, KS, 66160-7381, USA
| | - Lewis Satterwhite
- Division of Pulmonary, Critical Care, & Sleep Medicine, University of Kansas School of Medicine, 3901 Rainbow Boulevard, Mail Stop #3007, Kansas City, KS, 66160-7381, USA.
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9
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Gilbert JD, Neubauer K, Byard RW. Macroscopic identification of visceral titanium pigment in an intravenous drug user. J Forensic Sci 2021; 66:2024-2028. [PMID: 34117775 DOI: 10.1111/1556-4029.14779] [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: 03/16/2021] [Revised: 05/15/2021] [Accepted: 05/20/2021] [Indexed: 12/27/2022]
Abstract
Autopsy findings in intravenous drug addicts are quite variable and may involve a number of organ systems. Reports of the macroscopic identification at autopsy of components of tablets that have been crushed and injected are, however, exceedingly rare. The case of 34-year-old man who died of zolpidem toxicity on a background of pulmonary hypertension attributed to intravenous injections of crushed tablets is described. A very unusual finding was very fine white stippling on the cut surfaces of both the liver and spleen which was shown on energy-dispersive x-ray spectroscopy (EDS) to be titanium dioxide most likely from the coating of the zolpidem tablets. This case is significant in demonstrating titanium dioxide accumulation within organs at both macroscopic and microscopic levels, with confirmation of exposure by EDS analysis. The clinical significance of exposure to such high levels of titanium dioxide is unclear.
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Affiliation(s)
| | - Ken Neubauer
- Adelaide Microscopy, The University of Adelaide, Adelaide, SA, Australia
| | - Roger W Byard
- Forensic Science SA, Adelaide, SA, Australia.,Adelaide Medical School, The University of Adelaide, Adelaide, SA, Australia
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10
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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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11
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Vu M, Wisell J, Wohltmann W. Cutaneous foreign body microemboli-induced occlusive vasculopathy: A complication of illicit intravenous injection of oral opioid tablets. J Cutan Pathol 2021; 48:1173-1177. [PMID: 33934378 DOI: 10.1111/cup.14039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 04/20/2021] [Accepted: 04/28/2021] [Indexed: 10/21/2022]
Abstract
Occlusive nonvasculitic vasculopathy is a process characterized clinically by retiform purpura and potential ulceration and necrosis of affected areas, secondary to blockage of small vessels without associated inflammatory vasculitis. Intravascular injection of foreign material is known to cause distal ischemia and necrosis due to thrombosis, local vasoconstriction, or microemboli formation. A 27-year-old male presented with retiform purpura and worsening distal fingertip necrosis of the right upper extremity accompanied by suspicious intravascular polarizable foreign material identified on skin, muscle, and vascular biopsies. We report a case that highlights concerning complications and dermatopathologic findings of intravascular injection of oral opioid tablets.
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Affiliation(s)
- Marie Vu
- University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Joshua Wisell
- Department of Pathology, University of Colorado, Denver, Colorado, USA
| | - Wendi Wohltmann
- Department of Dermatology, Uniformed Services University of the Health Sciences, San Antonio Military Medical Center, San Antonio, Texas, USA
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12
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Blinick R, Chaya N, Zalta B, Haramati LB, Shmukler A. Cracking the Opium Den: Cardiothoracic Manifestations of Drug Abuse. J Thorac Imaging 2021; 36:W16-W31. [PMID: 32102017 DOI: 10.1097/rti.0000000000000488] [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: 11/25/2022]
Abstract
Recreational drug use is increasing worldwide, with emergency room visits and total deaths from drug overdose rising in recent years. Complications from prescription and recreational drug use may result from the biochemical effects of the drugs themselves, impurities mixed with substances, or from causes related to the method of drug administration. The presentation of drug overdose may be complex due to multisubstance abuse, including cigarette smoking and alcoholism, and can impact any organ system. Patients may present without history, and radiologists may be the first clinicians to suggest the diagnosis. We aim to explore the cardiothoracic manifestations of drug abuse and their multimodality imaging manifestations.
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Affiliation(s)
| | - Nathan Chaya
- Montefiore Medical Center, Bronx
- Staten Island University Hospital, Staten Island, NY
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13
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DiAngelo C, Rossi CT, Mourtzinos N, Huppmann AR. Clinically Unsuspected Injection Drug Abuse in Hospitalized Teens Diagnosed on Pathology. Pediatr Dev Pathol 2020; 23:404-407. [PMID: 32643542 DOI: 10.1177/1093526620935738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Intravenous injection of medications intended for oral use can lead to pulmonary hypertension and death. Pathologic findings in the lung include embolization of foreign material, with the specific identification of excipients accomplished through special stains. Risk factors for this type of drug abuse include indwelling venous access and chronic medical problems. These risk factors, especially in adolescent and young adult patients, should prompt intravenous drug use as a possibility of lung disease/lesions. We describe 2 patients from a pediatric hospital with pulmonary pathology indicative of intravenous drug use, identified in autopsy and surgical pathology cases. Drug abuse was not clinically suspected in either patient until the time of pathologic exam, emphasizing a need for the pathologist to be able to recognize the associated histologic changes.
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Affiliation(s)
- Constance DiAngelo
- Children's National Medical Center, Department of Pathology, Washington, District of Columbia
| | - Christopher T Rossi
- Children's National Medical Center, Department of Pathology, Washington, District of Columbia
| | | | - Alison R Huppmann
- Children's National Medical Center, Department of Pathology, Washington, District of Columbia
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14
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Koslik HJ, Joshua J, Cuevas-Mota J, Goba D, Oren E, Alcaraz JE, Garfein RS. Prevalence and correlates of obstructive lung disease among people who inject drugs, San Diego, California. Drug Alcohol Depend 2020; 214:108158. [PMID: 32652379 PMCID: PMC7331511 DOI: 10.1016/j.drugalcdep.2020.108158] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 06/12/2020] [Accepted: 06/23/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND Pulmonary tissue damage leading to obstructive lung disease (OLD) could result from intravenous administration of insoluble particles found in illicit drugs. This study described the prevalence and identified correlates of OLD among people who inject drugs (PWID). METHODS In 2012-2016, a community-based cohort of PWID who had injected within the past month were enrolled in a study to assess HIV, hepatitis C virus (HCV) andMycobacterium tuberculosis (Mtb) infections and their related risk factors. Data were obtained through face-to-face interviews, serological testing and spirometry. Baseline data were used for a cross-sectional analysis of the prevalence and correlates of OLD, defined as FEV1/FVC < 0.7. Univariate and multivariable logistic regression were used to identify factors associated with OLD. RESULTS Among 516 participants who had complete spirometry and interview results, the mean age was 43.3 years, 73.6 % were male, 9.5 % were Black, 91.1 % smoked cigarettes and 18.2 % had OLD. Few (9.6 %) PWID with OLD reported a previous diagnosis of COPD although many (44.7 %) reported related symptoms. Black race (AOR = 2.66, 95 %CI: 1.37, 5.17), pack-years smoked (AOR = 1.06/5 years, 95 %CI: 1.01, 1.12), and duration of injection drug use (AOR = 1.13, 95 %CI: 1.01, 1.27) were independently associated with OLD after controlling for age. CONCLUSIONS The prevalence of OLD was high in this cohort and associated with Black race and cigarette smoking-known risk factors. In addition, OLD prevalence increased with greater duration of injection drug use, suggesting a link between cumulative exposure to injected insoluble particles and OLD. Further examination of these adulterants and lung pathology are needed.
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Affiliation(s)
- Hayley J Koslik
- San Diego State University, School of Public Health, 5500 Campanile Drive, San Diego, CA, 92182, United States
| | - Jisha Joshua
- University of California San Diego, School of Medicine, 9500 Gilman Drive, La Jolla, CA, 92093, United States
| | - Jazmine Cuevas-Mota
- University of California San Diego, School of Medicine, 9500 Gilman Drive, La Jolla, CA, 92093, United States
| | - Daniel Goba
- University of California San Diego, School of Medicine, 9500 Gilman Drive, La Jolla, CA, 92093, United States
| | - Eyal Oren
- San Diego State University, School of Public Health, 5500 Campanile Drive, San Diego, CA, 92182, United States
| | - John E Alcaraz
- San Diego State University, School of Public Health, 5500 Campanile Drive, San Diego, CA, 92182, United States
| | - Richard S Garfein
- University of California San Diego, School of Medicine, 9500 Gilman Drive, La Jolla, CA, 92093, United States.
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15
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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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16
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Amass T, Cumplido J, Aswad B, Whittenhall M, Ventetuolo C, Klinger J. Rapid development of pulmonary hypertension and right ventricular failure due to large vessel intravascular microcrystalline cellulosis in an intravenous drug user. Pulm Circ 2020; 10:2045894020907871. [PMID: 32284846 DOI: 10.1177/2045894020907871] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Accepted: 01/12/2020] [Indexed: 11/16/2022] Open
Abstract
Intravascular foreign body deposition in the form of talc or microcrystalline cellulose is an uncommon but increasing cause of pulmonary hypertension given the current opioid epidemic. Earlier cases describe the effect of talc introduced via intravenous injection of crushed pills when deposited throughout the lungs, typically in the capillaries or distal pulmonary arterioles. An angiogranulomatous reaction ensues with pulmonary vascular remodeling and the gradual development of pulmonary hypertension. Although the use of talc in the manufacture of tablets has largely been replaced with alternative inert binders including microcrystalline cellulose, a similar angiogranulomatous reaction and vascular remodeling can occur. We report a case of intravascular microcrystalline cellulosis that rapidly progressed to fatal pulmonary hypertension over months characterized by occlusion of more proximal pulmonary arterioles in an intravenous drug user.
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Affiliation(s)
- Tim Amass
- Department of Medicine, Division of Pulmonary Critical Care and Sleep Medicine, Brown University, Providence, USA
| | - Jeffrey Cumplido
- Department of Medicine, Division of Pulmonary Critical Care and Sleep Medicine, Brown University, Providence, USA
| | - Basam Aswad
- Department of Medicine, Division of Pulmonary Critical Care and Sleep Medicine, Brown University, Providence, USA
| | - Mary Whittenhall
- Department of Medicine, Division of Pulmonary Critical Care and Sleep Medicine, Brown University, Providence, USA
| | - Corey Ventetuolo
- Department of Medicine, Division of Pulmonary Critical Care and Sleep Medicine, Brown University, Providence, USA
| | - James Klinger
- Department of Medicine, Division of Pulmonary Critical Care and Sleep Medicine, Brown University, Providence, USA
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17
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Kligerman S, Raptis C, Larsen B, Henry TS, Caporale A, Tazelaar H, Schiebler ML, Wehrli FW, Klein JS, Kanne J. Radiologic, Pathologic, Clinical, and Physiologic Findings of Electronic Cigarette or Vaping Product Use-associated Lung Injury (EVALI): Evolving Knowledge and Remaining Questions. Radiology 2020; 294:491-505. [PMID: 31990264 DOI: 10.1148/radiol.2020192585] [Citation(s) in RCA: 85] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Proposed as a safer alternative to smoking, the use of electronic cigarettes has not proven to be innocuous. With numerous deaths, there is an increasing degree of public interest in understanding the symptoms, imaging appearances, causes of, and treatment of electronic cigarette or vaping product use-associated lung injury (EVALI). Patients with EVALI typically have a nonspecific clinical presentation characterized by a combination of respiratory, gastrointestinal, and constitutional symptoms. EVALI is a diagnosis of exclusion; the patient must elicit a history of recent vaping within 90 days, other etiologies must be eliminated, and chest imaging findings must be abnormal. Chest CT findings in EVALI most commonly show a pattern of acute lung injury on the spectrum of organizing pneumonia and diffuse alveolar damage. The pathologic pattern found depends on when in the evolution of the disease process the biopsy sample is taken. Other less common forms of lung injury, including acute eosinophilic pneumonia and diffuse alveolar hemorrhage, have also been reported. Radiologists and pathologists help play an important role in the evaluation of patients suspected of having EVALI. Accurate and rapid identification may decrease morbidity and mortality by allowing for aggressive clinical management and glucocorticoid administration, which have been shown to decrease the severity of lung injury in some patients. In this review, the authors summarize the current state of the art for the imaging and pathologic findings of this disorder and outline a few of the major questions that remain to be answered.
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Affiliation(s)
- Seth Kligerman
- From the Department of Radiology, University of California, San Diego, 200 W Arbor Dr, #8756, San Diego, CA 92013 (S.K.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (C.R.); Department of Laboratory Medicine and Pathology, Mayo Clinic, Scottsdale, Ariz (B.L., H.T.); Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, Calif (T.S.H.); Laboratory for Structural, Physiologic and Functional Imaging, Department of Radiology, University of Pennsylvania Medical Center, Philadelphia, Pa (A.C., F.W.W.), Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (M.L.S., J.K.); and Department of Radiology, University of Vermont Medical Center, Burlington, Vt (J.S.K.)
| | - Costa Raptis
- From the Department of Radiology, University of California, San Diego, 200 W Arbor Dr, #8756, San Diego, CA 92013 (S.K.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (C.R.); Department of Laboratory Medicine and Pathology, Mayo Clinic, Scottsdale, Ariz (B.L., H.T.); Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, Calif (T.S.H.); Laboratory for Structural, Physiologic and Functional Imaging, Department of Radiology, University of Pennsylvania Medical Center, Philadelphia, Pa (A.C., F.W.W.), Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (M.L.S., J.K.); and Department of Radiology, University of Vermont Medical Center, Burlington, Vt (J.S.K.)
| | - Brandon Larsen
- From the Department of Radiology, University of California, San Diego, 200 W Arbor Dr, #8756, San Diego, CA 92013 (S.K.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (C.R.); Department of Laboratory Medicine and Pathology, Mayo Clinic, Scottsdale, Ariz (B.L., H.T.); Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, Calif (T.S.H.); Laboratory for Structural, Physiologic and Functional Imaging, Department of Radiology, University of Pennsylvania Medical Center, Philadelphia, Pa (A.C., F.W.W.), Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (M.L.S., J.K.); and Department of Radiology, University of Vermont Medical Center, Burlington, Vt (J.S.K.)
| | - Travis S Henry
- From the Department of Radiology, University of California, San Diego, 200 W Arbor Dr, #8756, San Diego, CA 92013 (S.K.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (C.R.); Department of Laboratory Medicine and Pathology, Mayo Clinic, Scottsdale, Ariz (B.L., H.T.); Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, Calif (T.S.H.); Laboratory for Structural, Physiologic and Functional Imaging, Department of Radiology, University of Pennsylvania Medical Center, Philadelphia, Pa (A.C., F.W.W.), Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (M.L.S., J.K.); and Department of Radiology, University of Vermont Medical Center, Burlington, Vt (J.S.K.)
| | - Alessandra Caporale
- From the Department of Radiology, University of California, San Diego, 200 W Arbor Dr, #8756, San Diego, CA 92013 (S.K.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (C.R.); Department of Laboratory Medicine and Pathology, Mayo Clinic, Scottsdale, Ariz (B.L., H.T.); Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, Calif (T.S.H.); Laboratory for Structural, Physiologic and Functional Imaging, Department of Radiology, University of Pennsylvania Medical Center, Philadelphia, Pa (A.C., F.W.W.), Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (M.L.S., J.K.); and Department of Radiology, University of Vermont Medical Center, Burlington, Vt (J.S.K.)
| | - Henry Tazelaar
- From the Department of Radiology, University of California, San Diego, 200 W Arbor Dr, #8756, San Diego, CA 92013 (S.K.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (C.R.); Department of Laboratory Medicine and Pathology, Mayo Clinic, Scottsdale, Ariz (B.L., H.T.); Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, Calif (T.S.H.); Laboratory for Structural, Physiologic and Functional Imaging, Department of Radiology, University of Pennsylvania Medical Center, Philadelphia, Pa (A.C., F.W.W.), Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (M.L.S., J.K.); and Department of Radiology, University of Vermont Medical Center, Burlington, Vt (J.S.K.)
| | - Mark L Schiebler
- From the Department of Radiology, University of California, San Diego, 200 W Arbor Dr, #8756, San Diego, CA 92013 (S.K.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (C.R.); Department of Laboratory Medicine and Pathology, Mayo Clinic, Scottsdale, Ariz (B.L., H.T.); Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, Calif (T.S.H.); Laboratory for Structural, Physiologic and Functional Imaging, Department of Radiology, University of Pennsylvania Medical Center, Philadelphia, Pa (A.C., F.W.W.), Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (M.L.S., J.K.); and Department of Radiology, University of Vermont Medical Center, Burlington, Vt (J.S.K.)
| | - Felix W Wehrli
- From the Department of Radiology, University of California, San Diego, 200 W Arbor Dr, #8756, San Diego, CA 92013 (S.K.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (C.R.); Department of Laboratory Medicine and Pathology, Mayo Clinic, Scottsdale, Ariz (B.L., H.T.); Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, Calif (T.S.H.); Laboratory for Structural, Physiologic and Functional Imaging, Department of Radiology, University of Pennsylvania Medical Center, Philadelphia, Pa (A.C., F.W.W.), Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (M.L.S., J.K.); and Department of Radiology, University of Vermont Medical Center, Burlington, Vt (J.S.K.)
| | - Jeffrey S Klein
- From the Department of Radiology, University of California, San Diego, 200 W Arbor Dr, #8756, San Diego, CA 92013 (S.K.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (C.R.); Department of Laboratory Medicine and Pathology, Mayo Clinic, Scottsdale, Ariz (B.L., H.T.); Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, Calif (T.S.H.); Laboratory for Structural, Physiologic and Functional Imaging, Department of Radiology, University of Pennsylvania Medical Center, Philadelphia, Pa (A.C., F.W.W.), Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (M.L.S., J.K.); and Department of Radiology, University of Vermont Medical Center, Burlington, Vt (J.S.K.)
| | - Jeffrey Kanne
- From the Department of Radiology, University of California, San Diego, 200 W Arbor Dr, #8756, San Diego, CA 92013 (S.K.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (C.R.); Department of Laboratory Medicine and Pathology, Mayo Clinic, Scottsdale, Ariz (B.L., H.T.); Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, Calif (T.S.H.); Laboratory for Structural, Physiologic and Functional Imaging, Department of Radiology, University of Pennsylvania Medical Center, Philadelphia, Pa (A.C., F.W.W.), Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (M.L.S., J.K.); and Department of Radiology, University of Vermont Medical Center, Burlington, Vt (J.S.K.)
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Rolader R, Bishop B, Eyre ZW, Cheeley JT. Crushed it: Elucidation of systemic vasculitis caused by injected hydromorphone tablets via skin biopsy. JAAD Case Rep 2019; 5:906-908. [PMID: 31649979 PMCID: PMC6804559 DOI: 10.1016/j.jdcr.2019.08.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Affiliation(s)
- Robin Rolader
- Emory University School of Medicine, Atlanta, Georgia
| | - Brian Bishop
- Department of Dermatology, Emory University, Atlanta, Georgia
| | - Zachary W. Eyre
- Department of Dermatology, Emory University, Atlanta, Georgia
| | - Justin T. Cheeley
- Department of Dermatology, Emory University, Atlanta, Georgia,Department of Medicine, Emory University, Atlanta, Georgia,Correspondence to: Justin T. Cheeley, MD, FAAD, Assistant Professor, Dermatology and Internal Medicine, Emory University School of Medicine, 1525 Clifton Rd. NE, Dermatology Office Suite 100, Office 122, Atlanta, GA 30322.
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19
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Keltanen TN, Heikman PK, Muhonen LH, Gunnar TO, Ojanperä IA. Enzymatic assay for urine lactose in the assessment of recent intravenous abuse of buprenorphine. Drug Test Anal 2019; 11:1412-1418. [DOI: 10.1002/dta.2654] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Revised: 05/15/2019] [Accepted: 05/17/2019] [Indexed: 12/18/2022]
Affiliation(s)
- Terhi N. Keltanen
- Forensic Toxicology UnitNational Institute for Health and Welfare Helsinki Finland
- Department of Forensic MedicineUniversity of Helsinki Helsinki Finland
| | - Pertti K. Heikman
- PsychiatryUniversity of Helsinki Helsinki Finland
- PsychiatryHelsinki University Central Hospital Helsinki Finland
| | - Leea H. Muhonen
- PsychiatryHelsinki University Central Hospital Helsinki Finland
| | - Teemu O. Gunnar
- Forensic Toxicology UnitNational Institute for Health and Welfare Helsinki Finland
| | - Ilkka A. Ojanperä
- Forensic Toxicology UnitNational Institute for Health and Welfare Helsinki Finland
- Department of Forensic MedicineUniversity of Helsinki Helsinki Finland
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20
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Self-Rated Physical Health and Unmet Healthcare Needs among Swedish Patients in Opioid Substitution Treatment. JOURNAL OF ADDICTION 2019; 2019:7942145. [PMID: 31139491 PMCID: PMC6500657 DOI: 10.1155/2019/7942145] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Accepted: 03/25/2019] [Indexed: 01/16/2023]
Abstract
Background Individuals with opioid dependence are at increased risk of deteriorating health due to the lifestyle connected to heroin use. Barriers surrounding the healthcare system seem to hinder patients to seek help through conventional healthcare, even after entering opioid substitution treatment (OST), resulting in a high level of unmet healthcare needs. However, this field is still unexplored, with only a few studies focusing on general health within this population. The first step, in order to provide suitable and accessible primary healthcare, is to assess the extent of physical symptoms and unmet healthcare needs within the OST population, which, to this point, has been sparsely studied. Aim To assess OST patients' self-rated physical health and healthcare seeking behaviour. Methods Two-hundred and eighteen patients from four different OST sites answered a questionnaire regarding physical health and healthcare seeking. Results Patients in OST have a high degree of physical symptoms and a high degree of unmet healthcare needs. Sixty-six percent reported suffering from musculoskeletal pain. Fifty-six percent reported gastrointestinal symptoms. Genital problems and airway symptoms were reported by 47%, respectively, and dental problems were reported by 69% of the respondents. General unmet healthcare needs were reported by 82%. Musculoskeletal pain was positively correlated with having an unstable housing situation (AOR 4.26 [95% CI 1.73-10.48]), negatively correlated with male sex (AOR 0.45 [95% CI 0.22-0.91]), and positively correlated with age (AOR 1.04 [95% CI 1.01-1.07]). No statistically significant correlates of respiratory, gastrointestinal, genital, or dental symptoms were found. Conclusion Patients in OST carry a heavy burden of physical symptoms and unmet healthcare needs, potentially due to societal barriers. Patients' frequent visits to the OST clinics offer a unique opportunity to build a base for easily accessible on-site primary healthcare.
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Rajagopala S, Kancherla R, Ganesan N, Balalakshmoji D, Karuppannasamy D, Ramanathan RP, Gopalan R. An unusual cause of breathlessness and profuse micronodules. Lung India 2018; 35:431-436. [PMID: 30168466 PMCID: PMC6120320 DOI: 10.4103/lungindia.lungindia_452_17] [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: 11/04/2022] Open
Abstract
We describe a 21-year-old male with a history of smoking and subacute onset of breathlessness with normal cardiorespiratory examination. The presence of "track marks" and digital infarcts prompted evaluation for infective endocarditis and confrontational history taking revealed anorexia, weight loss over 3 months along with intravenous drug abuse of reconstituted tablets of tapentadol. Echocardiography was normal and blood cultures were sterile; computed tomography showed bilateral, diffuse, small centrilobular nodules with "tree-in-bud" appearance. In this clinicopathologic conference, we discuss the clinical and radiological differential diagnosis of centrilobular nodules, lung biopsy findings, and management options for patients with such a presentation.
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Affiliation(s)
- Srinivas Rajagopala
- Department of Pulmonary Medicine, PSG Institute of Medical Sciences and Research, Coimbatore, Tamil Nadu, India
| | - Roopa Kancherla
- Department of Pulmonary Medicine, PSG Institute of Medical Sciences and Research, Coimbatore, Tamil Nadu, India
| | - Nidhya Ganesan
- Department of Pathology, PSG Institute of Medical Sciences and Research, Coimbatore, Tamil Nadu, India
| | - Devanand Balalakshmoji
- Department of Radiology, PSG Institute of Medical Sciences and Research, Coimbatore, Tamil Nadu, India
| | - Divya Karuppannasamy
- Department of Ophthalmology, PSG Institute of Medical Sciences and Research, Coimbatore, Tamil Nadu, India
| | | | - Rajendiran Gopalan
- Department of Cardiology, PSG Institute of Medical Sciences and Research, Coimbatore, Tamil Nadu, India
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22
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Milroy CM, Kepron C, Parai JL. Histologic Changes In Recreational Drug Misuse. Acad Forensic Pathol 2018; 8:653-691. [PMID: 31240063 DOI: 10.1177/1925362118797740] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Accepted: 07/24/2018] [Indexed: 11/15/2022]
Abstract
Use of recreational drugs is associated with a number of histologic changes. These may be related to the method of administration or due to systemic effects of the drugs. This paper reviews the histopathological features seen following recreational drug use. With injection, there may be local effects from abscess formation and systemic effects may result in amyloidosis. Injections have been associated with necrotizing fasciitis, anthrax, and clostridial infections. Systemic effects include infective endocarditis, with the risk of embolization, and abscesses may be seen in organs in the absence of infective endocarditis. Viral complications of injection include hepatitis and human immunodeficiency virus (HIV) infection. Injecting crushed tablets can result in intravascular granulomata in the lungs. Smoking drugs is associated with intraalveolar changes, including blackand brown-pigmented macrophages in crack cocaine and cannabis smoking, respectively. Snorting may result in intraalveolar granulomata forming when crush tablets are used and there may be systemic granulomata. Stimulants are associated with cardiovascular and cerebrovascular pathology, including contraction band necrosis and myocardial fibrosis, as well as coronary artery dissection. Stimulants may cause hyperpyrexia and rhabdomyolysis, which may be associated with changes in multiple organs including myoglobin casts in the kidney. Opioids cause respiratory depression and this can be associated with inhalational pneumonia and hypoxia in other organs if there is resuscitation and a period of survival. Ketamine use has been associated with changes in the urothelium and the liver. This paper reviews histology changes that may be seen in drug-related deaths using illustrative cases.
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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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24
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Abstract
Chronic thromboembolic pulmonary hypertension (CTEPH) is one of the potentially curable causes of pulmonary hypertension and is definitively treated with pulmonary thromboendartectomy. CTEPH can be overlooked, as its symptoms are nonspecific and can be mimicked by a wide range of diseases that can cause pulmonary hypertension. Early diagnosis of CTEPH and prompt evaluation for surgical candidacy are paramount factors in determining future outcomes. Imaging plays a central role in the diagnosis of CTEPH and patient selection for pulmonary thromboendartectomy and balloon pulmonary angioplasty. Currently, various imaging tools are used in concert, with techniques such as computed tomography (CT) and conventional pulmonary angiography providing detailed structural information, tests such as ventilation-perfusion (V/Q) scanning providing functional data, and magnetic resonance imaging providing a combination of morphologic and functional information. Emerging techniques such as dual-energy CT and single photon emission computed tomography-CT V/Q scanning promise to provide both anatomic and functional information in a single test and may change the way we image these patients in the near future. In this review, we discuss the roles of various imaging techniques and discuss their merits, limitations, and relative strengths in depicting the structural and functional changes of CTEPH. We also explore newer imaging techniques and the potential value they may offer.
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Affiliation(s)
- Anthony F. Henwood
- Histopathology Department, The Children’s Hospital at Westmead, Sydney, Australia
- School of Medicine, University of Western Sydney, Liverpool, Australia
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Abstract
Small airways disease, or bronchiolitis, encompasses many conditions that result in bronchiolar inflammation and/or fibrosis. Bronchioles are distal airways within secondary pulmonary lobules that are only visible on imaging when abnormal. High-resolution computed tomography plays an important role in diagnosing small airways disease. The predominant direct high-resolution computed tomography sign of bronchiolitis includes centrilobular nodules, whereas air trapping is the main indirect finding. This article reviews bronchiolar anatomy, discusses the differential diagnosis for cellular and constrictive bronchiolitis with a focus on key imaging features, and discusses how to distinguish important mimics.
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Affiliation(s)
- Abigail V Berniker
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, 505 Parnassus Avenue, San Francisco, CA 94143, USA
| | - Travis S Henry
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, 505 Parnassus Avenue, San Francisco, CA 94143, USA.
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Warren MB, Stabler J, Hagman MM. Intravenous melatonin abuse leading to recurrent aortic valve endocarditis: a case report and discussion. BMC Psychiatry 2016; 16:39. [PMID: 26911800 PMCID: PMC4765112 DOI: 10.1186/s12888-016-0754-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Accepted: 02/17/2016] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Reports of inappropriate medication use are widespread. There is a growing literature detailing abuse of drugs not typically thought to have high abuse liability. Melatonin is considered to be generally safe and is categorized by the Food and Drug Administration as a nutritional supplement. There are no known reports of intravenous melatonin abuse in the medical literature. CASE PRESENTATION The authors report a case of a patient injecting melatonin with euphoric and then sedative effects leading to two episodes of infective endocarditis culminating in aortic valve replacement. CONCLUSION Infective endocarditis continues to be a major potential complication of intravenous drug abuse. The proliferation of novel street drugs, resurgence in the use of older drugs and ongoing abuse of medications warrant continued research and vigilance in treating substance use disorders and attendant medical complications.
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Affiliation(s)
- Mark B. Warren
- Department of Psychiatry, University of Washington, Boise Veterans Administration Medical Center, 500 W. Fort St., Boise, ID 83702 USA
| | - Jonathan Stabler
- Department of Internal Medicine, University of Washington, Boise Veterans Administration Medical Center, 500 W. Fort St., Boise, ID, 83702, USA.
| | - Melissa M. Hagman
- Department of Internal Medicine, University of Washington, Boise Veterans Administration Medical Center, 500 W. Fort St., Boise, ID 83702 USA
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Mushtaq J, Walker A, Hunter B. Under pressure: progressively enlarging facial mass following high-pressure paint injection injury. BMJ Case Rep 2016; 2016:bcr-2015-212817. [PMID: 26786528 DOI: 10.1136/bcr-2015-212817] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
High-pressure paint injection injuries are relatively rare industrial accidents and almost exclusively occur on the non-dominant hand. A rarely documented complication of these injuries is the formation of a foreign body granuloma. We report a case of a 33-year-old man presenting with extensive facial scarring and progressive right paranasal swelling 7 years after a high-pressure paint injury. After imaging investigations, an excision of the mass and revision of scarring was performed. Access to the mass was gained indirectly through existing scarring over the nose to ensure an aesthetic result. Histological analysis revealed a florid granulomatous foreign body reaction to retained paint. To the best of our knowledge, this is the first reported case of a facial high-pressure paint injury with consequent formation of a foreign body granuloma.
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Affiliation(s)
| | | | - Ben Hunter
- St George's University of London, London, UK
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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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