IS Case 560: Crack pipe
Imaging Sciences URMC 2010
Publication Date: 2011-11-16
History
Patient is a 40-year-old female combative in the emergency department after assault and trauma to the chest.
Findings
Single supine AP view of the chest demonstrated a tubular structure projecting over the left lower lung field.
Diagnosis
Crack pipe
Discussion
Although foreign bodies are often ingested or inserted into the patient, identification of overlying objects can be important to making a diagnosis. Radiologic technologists routinely remove as many overlying objects as is feasible from a patient when acquiring a portable radiograph. However, in certain risk groups, contraband often appears in the field of view. In this case, the etiology of patient's altered mental status was determined by the identification of a crack pipe hidden in her bra.
Foreign objects incidentally found during radiologic studies often involve groups such as children, mentally handicapped, and individuals involved with illegal activities such as drug use. Ingested items appearing radiographically opaque include glass, metals, certain medications and poisons, however the majority of medications are not radiopaque. Ingested drugs carried by smugglers may be identified in the gastrointestinal tract as either opaque or lucent depending on the material. Although theoretically foreign body ingestion puts patients at risk for viscus perforation, this only occurs in about 1% of cases.
While the lungs in the patient presented above were normal, the use of crack cocaine is notable for its pulmonary complications, which may present with acute injuries such as pneumothorax, pulmonary edema, hemorrhage and pneumonitis as part of a syndrome referred to as crack lung. Patients with chronic use may present with findings of chronic interstitial disease, bronchiolitis obliterans or emphysema.
References
- Hunter TB, Taljanovic MS. Foreign bodies. Radiographics. 2003 May-Jun;23(3):731-57. PMID: 12740473
- Restrepo CS, Carrillo JA, Martínez S, Ojeda P, Rivera AL, Hatta A. Pulmonary complications from cocaine and cocaine-based substances: imaging manifestations. Radiographics. 2007 Jul-Aug;27(4):941-56. PMID: 17620460
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