Journal of thoracic imaging
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Drug-related diseases of the lungs have been noted with increasing frequency in urban patients. These entities are also being seen in smaller urban and suburban settings, however. The spectrum of pathology is also changing coincident with the marked increase in crack cocaine use. ⋯ Pulmonary complications related to injections of illicit drugs have included pulmonary infection, pulmonary edema, particulate embolism, and talcosis. The "pocket shot" places the patient at risk for a unique set of complications. Radiologists should be aware of this wide spectrum of pulmonary disease that may be related to this increasingly frequent social problem.
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The review provides an update of drug-induced pulmonary disorders, focusing on newer agents whose effects on the lung have been studied recently. Included among these drugs are cyclosporine, cytosine arabinoside (Ara-C), amiodarone, interleukin-2 (IL-2), OKT3, tricyclic antidepressants, and bromocriptine. A brief review of the most common cytotoxic and noncytotoxic agents causing pulmonary toxicity is also included.
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Several acute and chronic conditions that alter the integrity of the pulmonary epithelium increased the rate of absorption or clearance into the circulation of small solutes deposited in the alveoli. Technetium 99m diethylenetriamine pentaacetic acid can be deposited in the lungs as a submicronic aerosol and its rate of clearance measured with a gamma camera or simple probe. This clearance technique is currently being used to evaluate patients who have developed pulmonary edema and also to detect those patients from a high risk group who are likely to develop adult respiratory distress syndrome (ARDS). ⋯ It is clear that a single measurement in patients who smoke is not useful, but repeated measurements may provide important information. The lung clearance measurement is very sensitive to changes in epithelial integrity but is not specific for ARDS. It may be most useful in combination with other predictive tests or when the clearance rate is normal.
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The anatomic and physiologic response to positive end-expiratory pressure (PEEP) was investigated using computed tomography (CT) in patients with adult respiratory distress syndrome (ARDS). The lesions (densities) in ARDS are distributed inhomogeneously but tend to concentrate in the dependent regions. The estimated lung weight (by CT scan, quantitative analysis, and lung gas volume measured with helium dilution) is, on the average, 200% higher than expected. ⋯ The main effect of PEEP is to clear the densities through alveolar anatomic recruitment. Anatomic recruitment changes the mechanical characteristics of the lung and parallels the improvement in gas exchange. The effects of PEEP on pulmonary arterial pressure appear to be related to anatomic recruitment.
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The most important lung alterations associated with blunt trauma are contusion, laceration, and diffuse alveolar damage. The first two are the direct consequences of injury to the chest, while the third is the indirect result of thoracic or nonthoracic trauma. In addition to these three conditions, there are a number of epiphenomena and less common posttrauma abnormalities that are important to the radiologist involved in the care of injured patients.