Crack lung

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.

Clinical presentation

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 .

Pathology

Histological changes include :

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 nonspecific and include :

pulmonary alveolar and interstitial edema, predominantly perihilar
pulmonary hemorrhage
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 .

Complications

acute respiratory distress syndrome (ARDS)
end-stage respiratory failure