Crack lung is a term used to describe one of the respiratory complications of smoked crack cocaine.
Patients present with sympathetic hyperactivity such as tachycardia, hypertension, dilated pupils, and chest pain, productive cough, dyspnoea, and hypoxaemia along with fever, haemoptysis, and respiratory failure 1,3.
Histological changes include 1:
- diffuse alveolar damage
- alveolar haemorrhage
- interstitial/alveolar infiltration by inflammatory cells, typically eosinophils as well as peripheral eosinophilia (up to 40%)
Plain radiograph and CT
Reported features are nonspecific and include 2,3,4:
- pulmonary alveolar and interstitial oedema, predominantly perihilar
- pulmonary haemorrhage
- barotrauma: pneumothorax; pneumomediastinum; pneumopericardium
- localised atelectasis or consolidation
- empyema rich in eosinophils
Treatment and prognosis
Mild cases resolve with conservative management and severe cases are usually treated with corticosteroids 1.
- 1. Devlin RJ, Henry JA. Clinical review: Major consequences of illicit drug consumption. Crit Care. 2008;12 (1): 202. doi:10.1186/cc6166 - Free text at pubmed - Pubmed citation
- 2. Hagan IG, Burney K. Radiology of recreational drug abuse. Radiographics. 2007;27 (4): 919-40. doi:10.1148/rg.274065103 - Pubmed citation
- 3. Mançano A, Marchiori E, Zanetti G et-al. Pulmonary complications of crack cocaine use: high-resolution computed tomography of the chest. J Bras Pneumol.34 (5): 323-7. doi:10.1590/S1806-37132008000500012 - Pubmed citation
- 4. Wright FW. Radiology of the chest and related conditions. CRC Press. ISBN:0415281415. Read it at Google Books - Find it at Amazon
- 5. Restrepo CS, Carrillo JA, Martínez S et-al. Pulmonary complications from cocaine and cocaine-based substances: imaging manifestations. Radiographics. 2007;27 (4): 941-56. doi:10.1148/rg.274065144 - Pubmed citation