Monday, September 8, 2014

Crackles


A 50 year old man presents with shortness of breath and a cough two days after taking the substance above. He also has melanoptysis (that is, black sputum). He has thermal burns on his thumbs. He is hypoxic and a bronchoscopy is performed. The bronch shows bloody lavage. Cell count shows eosinophilia. The CXR and CT are shown below.


Challenge: What's the diagnosis?

First image is in the public domain, second image is shown under Fair Use.

4 comments:

Anonymous said...

crack coccaine addict!

Craig Chen said...

don't mind the pun in the title - you're right :)
-
Crackles

This is crack lung, acute pulmonary toxicity manifested by diffuse alveolar damage and hemorrhagic alveolitis. It is due to smoking crack (free-based cocaine). Melanoptysis is probably due to inhalation of carbonaceous residue. The CXR shows basilar opacities. The CT shows bilateral ground glass opacities.

Sources: UpToDate; Wikipedia.

Anonymous said...

He have some mild scoliosis going on as well?

Craig Chen said...

yep - i think that's true - clavicles look pretty symmetric and you can see some scoliotic changes in the spine