IS case 461: Cocaine induced lung disease

Keith Forrest Dockery, MD, MS

University of Rochester

Imaging Sciences URMC 2010
Publication Date: 2010-08-30


Patient is a 40-year-old male with chest pain and history of cocaine abuse.


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Cocaine induced lung disease


Cocaine has numerous pulmonary complications and is the most common illicit drug in the emergency department.

Cocaine abuse results in imaging for the following indications: Cough, chest pain, barotrauma, airway injury, pulmonary edema, asthma (severe), hemorrhage, infarct, interstitial lung disease, crack lung, pneumonia, emphysema, pulmonary hypertension, lymphadenopathy.

Crack is a commonly inhaled form, containing innumerable contaminants. Cough with sputum is the most common acute respiratory complaint (61%). In one series, one-half of emergency department chest films on cocaine abusers were abnormal. Chest pain is the most common cardiopulmonary complaint (56%).

The current case imaging suggested crack lung. However, chronic interstitial thickening was not seen on follow-up high resolution CT. Nonetheless, the lung appearance is consistent with acute edema or atelectasis on plain film, secondary to crack/cocaine use. The second patient shown has progressive interstitial disease with acute edema, compatible with longstanding cocaine induced interstitial disease with superimposed cocaine induced acute myocardial infarction.


  1. Restrepo CS, Carrillo JA, Martínez S, et al. Pulmonary complications from cocaine and cocaine-based substances: imaging manifestations. Radiographics. 2007 Jul-Aug;27(4):941-56. PMID: 17620460

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