Case-based Exhibit Highlights Trends in Drug-Induced Lung Injury

Substance use-related mortality is a multifactorial issue, according to Brandon Koo, MD, a diagnostic radiology resident at the Brown Radiology Chest Imaging Department in Providence, RI, who noted that drug overdoses are a leading cause of death in the U.S.

In an education exhibit that offered a case-based review of recreational drug-induced lung injury, Dr. Koo emphasized the need for radiologists—particularly those who work in the emergency department setting—to stay informed about trends in the use and abuse of these substances and their impact on lung and cardiovascular health.

“Cardiopulmonary findings of recreational substance abuse are as varied as they are widespread,” Dr. Koo said. “But, there are clear patterns that arise based on the substance itself, the route of administration and the overall chronicity of substance use.”

To understand where to look for drug-induced injury, radiologists should consider the routes of administration. “The cardiothoracic system and the lungs in particular are where we often see the effects of recreational substance use manifest, particularly with the increasing availability and incidence of inhalational substance abuse,” Dr. Koo said.

Among several examples, Dr. Koo presented cases that included e-cigarette or vaping product use-associated lung injury (EVALI), which have recently become more prevalent in young adults. He noted that acute lung injury is the most common imaging pattern of EVALI. “CT imaging features in these patients typically include multifocal ground-glass opacities with or without consolidation, centrilobular nodules and septal thickening,” Dr. Koo said.

The potential for lung injury goes beyond damage caused by inhalants. “The lungs remain a key part of the story in intravenous drug abuse as well,” Dr. Koo said. “For example, in the case of excipient lung disease, where crushed drug tablet particles embolize to the pulmonary arterial system and result in both acute and long-term injury with repeat abuse.”

He shared case examples of CT imaging findings in excipient lung disease and discussed the more rare but serious complications of intravascular foreign body embolization resulting from intravenous drug use. “Central embolization of needle fragments and IV drug paraphernalia can lead to both cardiac and pulmonary complications,” Dr. Koo said.

“Patients with recreational substance use, particularly via inhalation route, may present with acute onset dyspnea that limits evaluation of the lungs due to respiratory motion. In other cases, patients may be too obtunded or acutely ill to follow instructions while managing imaging, which can limit evaluation as well,” Dr. Koo said.

Challenges experienced in clinical care for these patients extended to the research environment where the stigma of drug abuse was a factor faced by Dr. Koo and his team.

“One of the major setbacks in finding appropriate cases for this exhibit was the fact that patients were often unable to provide an adequate history as to how they came to the hospital, either due to their acute state or because understandably they may not be entirely forthcoming with substance abuse history,” Dr. Koo said.

Access the education exhibit, “Wreck-Reational Drug Induced Lung Injury,” (CHEE-23) on demand at RSNA.org/MeetingCentral.