• Renata Rocha de Almeida, Gláucia Zanetti, Arthur Soares Souza, Luciana Soares de Souza, Jorge Luiz Pereira E Silva, Dante Luiz Escuissato, Klaus Loureiro Irion, Alexandre Dias Mançano, Luiz Felipe Nobre, Bruno Hochhegger, and Edson Marchiori.
• Universidade Federal do Rio de Janeiro, Rio de Janeiro, BR.
• J Bras Pneumol. 2015 Jul 1; 41 (4): 323-30.

ObjectiveTo evaluate HRCT scans of the chest in 22 patients with cocaine-induced pulmonary disease.MethodsWe 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.ResultsIn 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.ConclusionsPulmonary 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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