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.
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Clinical presentation
Patients present within 48 hours of cocaine insufflation with respiratory failure and signs of 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.
Pathology
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%)
Radiographic features
Plain radiograph and CT
Reported features are non-specific and include 2-4:
pulmonary alveolar and interstitial edema, predominantly perihilar
barotrauma: pneumothorax; pneumomediastinum; pneumopericardium
localized 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.
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