Crack lung

Last revised by Dr Daniel J Bell on 18 Aug 2021

Crack lung is a term used to describe an acute pulmonary injury related to smoked crack cocaine.

On imaging, it is characterized by interstitial and alveolar lung opacities with a diffuse distribution and commonly involving the perihilar regions. 

Patients present with sympathetic hyperactivity such as tachycardia, hypertension, dilated pupils, and chest pain, productive cough, dyspnea, and hypoxemia along with fever, hemoptysis, and respiratory failure 1,3

Histological changes include 1:

  • diffuse alveolar damage
  • alveolar hemorrhage
  • interstitial/alveolar infiltration by inflammatory cells, typically eosinophils as well as peripheral eosinophilia (up to 40%)

Reported features are non-specific and include 2-4:

Mild cases resolve with conservative management and severe cases are usually treated with corticosteroids 1

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Cases and figures

  • Case 1: plain radiograph
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  • Case 1: CT
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  • Case 2
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  • Case 3
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