171Lu Acute Inhalational Crack Injury

  • 30 yo female with h/o
    • DM2,
    • substance abuse disorder.
    • recent
      • smoking/inhaling crack cocaine 1 week prior
      • developed a cough productive of thick brownish sputum,
      • dyspnea
      • Clinical
        • afebrile
        • sat=93% on 4L
        • chest is clear, h
      • Imaging

Normal CXR  3 Years Ago 

Normal CXR 3 years Earlier
Ashley Davidoff MD TheCommonVein.net crack-injury-001-

CXR on day of admission

diffuse bilateral pulmonary alveolar infiltrates

CXR shows iffuse bilateral pulmonary alveolar infiltrates
Ashley Davidoff MD TheCommonVein.net crack-injury-002

CT scan on day of admission shows diffuse predominantly ground glass opacities dominant  in upper and mid lung fields, with subpleural sparing, and basilar sparing, particulalrly in the basal recesses

CT scan on day of admission shows diffuse predominantly ground glass opacities dominant  in upper and mid lung fields, with subpleural sparing, and basilar sparing, particulalrly in the basal recesses 
Ashley Davidoff MD TheCommonVein.net crack-injury-003
CT scan on day of admission shows diffuse predominantly ground glass opacities dominant  in upper and mid lung fields, with subpleural sparing, and basilar sparing, particulalrly in the basal recesses 
Ashley Davidoff MD TheCommonVein.net crack-injury-004
CT scan on day of admission shows diffuse predominantly ground glass opacities dominant  in upper and mid lung fields, with subpleural sparing, and basilar sparing, particulalrly in the basal recesses 
Ashley Davidoff MD TheCommonVein.net crack-injury-004 d
CT scan on day of admission shows diffuse predominantly ground glass opacities dominant  in upper and mid lung fields, with subpleural sparing, and basilar sparing, particulalrly in the basal recesses 
Ashley Davidoff MD TheCommonVein.net crack-injury-004 e
CT scan on day of admission shows diffuse predominantly ground glass opacities dominant  in upper and mid lung fields, with subpleural sparing, and basilar sparing, particulalrly in the basal recesses 
Ashley Davidoff MD TheCommonVein.net crack-injury-005
CT scan on day of admission shows diffuse predominantly ground glass opacities dominant  in upper and mid lung fields, with subpleural sparing, and basilar sparing, particulalrly in the basal recesses 
Ashley Davidoff MD TheCommonVein.net crack-injury-006
CT scan on day of admission shows diffuse predominantly ground glass opacities dominant  in upper and mid lung fields, with subpleural sparing, and basilar sparing, particulalrly in the basal recesses 
Ashley Davidoff MD TheCommonVein.net crack-injury-007
CT scan on day of admission shows diffuse predominantly ground glass opacities dominant  in upper and mid lung fields, with subpleural sparing, and basilar sparing, particulalrly in the basal recesses 
Ashley Davidoff MD TheCommonVein.net crack-injury-008
CT scan on day of admission shows diffuse predominantly ground glass opacities dominant  in upper and mid lung fields, with subpleural sparing, and basilar sparing, particulalrly in the basal recesses 
Ashley Davidoff MD TheCommonVein.net crack-injury-009
CT scan on day of admission shows diffuse predominantly ground glass opacities dominant  in upper and mid lung fields, with subpleural sparing, and basilar sparing, particulalrly in the basal recesses 
Ashley Davidoff MD TheCommonVein.net crack-injury-010
CT scan on day of admission liver cirrhosis and splenomegaly
Ashley Davidoff MD TheCommonVein.net crack-injury-010
CXR 4 days later shows persistent but improvong diffuse bilateral pulmonary alveolar infiltrates
Ashley Davidoff MD TheCommonVein.net crack-injury-012

 

 

        • upper lobes
        • central lung and
        • bronchovascular bundles.
        • diffuse bilateral pulmonary alveolar infiltrates
        • GGOs
        • sparing of the periphery and bases. Her infiltrates are worst in the and have preference for the
      • Progress
        • Within a day clinical improvement