Presentation
2-week history of dyspnea.
Patient Data
Innumerable small well-defined nodules in both lungs with confluent lingular nodules. Central line tip at the cavoatrial junction, no pneumothorax, no pleural effusion.
CT confirms innumerable small lung nodules with confluent lingular nodules. The nodules spare pleural and fissural surfaces and many are clustered, indicating that they are centrilobular. There is no lymphadenopathy or pleural/pericardial effusion.
Case Discussion
The patient is a drug user who crushed and then injected pills intravenously through a central line. This history combined with the CT findings of centrilobular nodules makes excipient lung disease the most likely diagnosis. The nodules are a granulomatous response to the inert "filler" in pills.
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