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KEY FACTS
Terminology
Imaging
Top Differential Diagnoses
Pathology
Clinical Issues
TERMINOLOGY
Synonyms
- Excipient lung disease (ELD)
- Angiocentric systemic granulomatosis
- Pulmonary angiothrombotic granulomatosis
- Pulmonary granulomatous vasculitis
- Pulmonary foreign body angiogranulomatosis
- Pulmonary mainline granulomatosis
- Talc embolism
- Foreign body microembolism
- Foreign body granulomatosis
- Intravascular talcosis
- Ritalin lung
Definitions
- Occlusion of pulmonary arterioles and capillaries by insoluble foreign body particles from intravenous (IV) injection of crushed tablets intended for oral use only, which leads to acute or chronic cor pulmonale
- Oral tablets contain active and inactive components
- Inactive components (excipients)
- Can be referred to as binders or fillers
- Provide stabilization, bulk, substance, or therapeutic enhancement
- Cellulose (most common)
- Talc (common but decreasing in frequency)
- Other (less common)
- Corn starch
- Cotton fibers
- Crospovidone
- Inactive components (excipients)
- Ritalin (methylphenidate) contains talc
- Associated with panlobular emphysema
- Likely triggered by drug itself with talc coadjuvancy
- Definite association of emphysema with IV Ritalin abuse
- Association of long-term appropriate oral Ritalin use with emphysema has been postulated
- Likely triggered by drug itself with talc coadjuvancy
- Associated with panlobular emphysema
IMAGING
General Features
Radiographic Findings
CT Findings
Imaging Recommendations
DIFFERENTIAL DIAGNOSIS
PATHOLOGY
General Features
CLINICAL ISSUES
Presentation
Natural History & Prognosis
Treatment
DIAGNOSTIC CHECKLIST
Consider
Selected References
- Boonsarngsuk V et al: A case of recurrent pneumothorax related to oral methylphenidate. J Thorac Dis. 7(8):E255-7, 2015
- Hamilton HH et al: The importance of microscopic examination of the lungs in decedents with sustained central intravascular catheters: a nine-case series. J Forensic Sci. 60(2):346-50, 2015
- Rapello GV et al: Pulmonary emphysema induced by methylphenidate: experimental study. Sao Paulo Med J. 133(2):131-4, 2015
- Altraja A et al: Pulmonary intravascular talcosis mimicking miliary tuberculosis in an intravenous drug addict. BMJ Case Rep, 2014
- de Almeida RR et al: High-resolution computed tomographic findings of cocaine-induced pulmonary disease: a state of the art review. Lung. 192(2):225-33, 2014
- Nguyen VT et al: Pulmonary effects of i.v. injection of crushed oral tablets: "excipient lung disease". AJR Am J Roentgenol. 203(5):W506-15, 2014
- Bach AG et al: Imaging of nonthrombotic pulmonary embolism: biological materials, nonbiological materials, and foreign bodies. Eur J Radiol. 82(3):e120-41, 2013
- Shrestha B et al: Sudden death by acute cor pulmonale from intravenous drug abuse during an inpatient admission: implications for unexplained in-hospital death. Clinical Pulmonary Medicine. 20(4): 192-5, 2013
- Griffith CC et al: Intravascular talcosis due to intravenous drug use is an underrecognized cause of pulmonary hypertension. Pulm Med. 2012:617531, 2012
- Pena E et al: Nonthrombotic pulmonary embolism: a radiological perspective. Semin Ultrasound CT MR. 33(6):522-34, 2012
- Chute DJ et al: Angiocentric systemic granulomatosis. Am J Forensic Med Pathol. 31(2):146-50, 2010
- Jorens PG et al: Nonthrombotic pulmonary embolism. Eur Respir J. 34(2):452-74, 2009
- Ganesan S et al: Embolized crospovidone (poly[N-vinyl-2-pyrrolidone]) in the lungs of intravenous drug users. Mod Pathol. 16(4):286-92, 2003
- Bendeck SE et al: Cellulose granulomatosis presenting as centrilobular nodules: CT and histologic findings. AJR Am J Roentgenol. 177(5):1151-3, 2001
- Ward S et al: Talcosis associated with IV abuse of oral medications: CT findings. AJR Am J Roentgenol. 174(3):789-93, 2000
- Diaz-Ruiz MJ et al: Cellulose granulomatosis of the lungs. Eur Radiol. 9(6):1203-4, 1999
- Stern EJ et al: Panlobular pulmonary emphysema caused by i.v. injection of methylphenidate (Ritalin): findings on chest radiographs and CT scans. AJR Am J Roentgenol. 162(3):555-60, 1994
- Pare JP et al: Long-term follow-up of drug abusers with intravenous talcosis. Am Rev Respir Dis. 139(1):233-41, 1989
- Sudden death IV drug abuse
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References
Tables
Tables
KEY FACTS
Terminology
Imaging
Top Differential Diagnoses
Pathology
Clinical Issues
TERMINOLOGY
Synonyms
- Excipient lung disease (ELD)
- Angiocentric systemic granulomatosis
- Pulmonary angiothrombotic granulomatosis
- Pulmonary granulomatous vasculitis
- Pulmonary foreign body angiogranulomatosis
- Pulmonary mainline granulomatosis
- Talc embolism
- Foreign body microembolism
- Foreign body granulomatosis
- Intravascular talcosis
- Ritalin lung
Definitions
- Occlusion of pulmonary arterioles and capillaries by insoluble foreign body particles from intravenous (IV) injection of crushed tablets intended for oral use only, which leads to acute or chronic cor pulmonale
- Oral tablets contain active and inactive components
- Inactive components (excipients)
- Can be referred to as binders or fillers
- Provide stabilization, bulk, substance, or therapeutic enhancement
- Cellulose (most common)
- Talc (common but decreasing in frequency)
- Other (less common)
- Corn starch
- Cotton fibers
- Crospovidone
- Inactive components (excipients)
- Ritalin (methylphenidate) contains talc
- Associated with panlobular emphysema
- Likely triggered by drug itself with talc coadjuvancy
- Definite association of emphysema with IV Ritalin abuse
- Association of long-term appropriate oral Ritalin use with emphysema has been postulated
- Likely triggered by drug itself with talc coadjuvancy
- Associated with panlobular emphysema
IMAGING
General Features
Radiographic Findings
CT Findings
Imaging Recommendations
DIFFERENTIAL DIAGNOSIS
PATHOLOGY
General Features
CLINICAL ISSUES
Presentation
Natural History & Prognosis
Treatment
DIAGNOSTIC CHECKLIST
Consider
Selected References
- Boonsarngsuk V et al: A case of recurrent pneumothorax related to oral methylphenidate. J Thorac Dis. 7(8):E255-7, 2015
- Hamilton HH et al: The importance of microscopic examination of the lungs in decedents with sustained central intravascular catheters: a nine-case series. J Forensic Sci. 60(2):346-50, 2015
- Rapello GV et al: Pulmonary emphysema induced by methylphenidate: experimental study. Sao Paulo Med J. 133(2):131-4, 2015
- Altraja A et al: Pulmonary intravascular talcosis mimicking miliary tuberculosis in an intravenous drug addict. BMJ Case Rep, 2014
- de Almeida RR et al: High-resolution computed tomographic findings of cocaine-induced pulmonary disease: a state of the art review. Lung. 192(2):225-33, 2014
- Nguyen VT et al: Pulmonary effects of i.v. injection of crushed oral tablets: "excipient lung disease". AJR Am J Roentgenol. 203(5):W506-15, 2014
- Bach AG et al: Imaging of nonthrombotic pulmonary embolism: biological materials, nonbiological materials, and foreign bodies. Eur J Radiol. 82(3):e120-41, 2013
- Shrestha B et al: Sudden death by acute cor pulmonale from intravenous drug abuse during an inpatient admission: implications for unexplained in-hospital death. Clinical Pulmonary Medicine. 20(4): 192-5, 2013
- Griffith CC et al: Intravascular talcosis due to intravenous drug use is an underrecognized cause of pulmonary hypertension. Pulm Med. 2012:617531, 2012
- Pena E et al: Nonthrombotic pulmonary embolism: a radiological perspective. Semin Ultrasound CT MR. 33(6):522-34, 2012
- Chute DJ et al: Angiocentric systemic granulomatosis. Am J Forensic Med Pathol. 31(2):146-50, 2010
- Jorens PG et al: Nonthrombotic pulmonary embolism. Eur Respir J. 34(2):452-74, 2009
- Ganesan S et al: Embolized crospovidone (poly[N-vinyl-2-pyrrolidone]) in the lungs of intravenous drug users. Mod Pathol. 16(4):286-92, 2003
- Bendeck SE et al: Cellulose granulomatosis presenting as centrilobular nodules: CT and histologic findings. AJR Am J Roentgenol. 177(5):1151-3, 2001
- Ward S et al: Talcosis associated with IV abuse of oral medications: CT findings. AJR Am J Roentgenol. 174(3):789-93, 2000
- Diaz-Ruiz MJ et al: Cellulose granulomatosis of the lungs. Eur Radiol. 9(6):1203-4, 1999
- Stern EJ et al: Panlobular pulmonary emphysema caused by i.v. injection of methylphenidate (Ritalin): findings on chest radiographs and CT scans. AJR Am J Roentgenol. 162(3):555-60, 1994
- Pare JP et al: Long-term follow-up of drug abusers with intravenous talcosis. Am Rev Respir Dis. 139(1):233-41, 1989
- Sudden death IV drug abuse
