What is the role of imaging studies in the workup of cocaine toxicity?

Updated: Dec 31, 2020
  • Author: Lynn Barkley Burnett, MD, EdD, JD; Chief Editor: Sage W Wiener, MD  more...
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Obtain a chest radiograph in patients with chest pain, hypoxia, or moderate-to-severe toxicity. The chest radiograph may reveal diffuse granulomatous changes resulting from chronic parenteral use due to the injection of inert insoluble ingredients of oral preparations or insolubles used to cut cocaine (eg, talc). Septic pulmonary emboli appear round or wedge shaped; they may clear rapidly or cavitate. Aspiration pneumonitis and noncardiogenic pulmonary edema may also be demonstrated. Pulmonary abscess may become evident after aspiration pneumonitis or after an intravenous injection of bacteria or toxic organic or inorganic materials.

The chest radiograph may reveal a needle that was lost during drug injection. An aneurysm or pseudoaneurysm may be noted with mainlining (directly injecting into a central artery or vein); this finding is an indication for further imaging studies.

Radiographs may be useful to evaluate cellulitis, abscess, or nonhealing wound in an intravenous drug user, and may reveal a foreign body or subcutaneous emphysema produced by gas-forming organisms in an anaerobic infection. Ultrasonography may identify foreign body or abscess.

Skeletal images can reveal osteomyelitis or fractures. However, osteomyelitis may not be demonstrable on plain images for 1-2 weeks, and other imaging studies should be performed if such a diagnosis is considered.

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