Epidemiology
- Prevalence: talc granulomatosis occurs in 15-80% of addicts (by autopsy studies): depending on type of addiction (ie: drug used)
Etiology and Physiology
IV Injection of Talc (Magnesium Silicate) (see Talc, [[Talc]])
- Etiology: intravenous injection of talc, which is commonly used as a filler for drugs of abuse
- Orally-Formulated Drugs of Abuse: talc or starch fillers are commonly used in the intravenous injection of orally-formulated drugs
- Meperidine (Demerol) (see Meperidine, [[Meperidine]])
- Methlyphenidate (Ritalin) (see Methylphenidate, [[Methylphenidate]])
- Methadone (see Methadone, [[Methadone]])
- Hydromorphone (Dilaudid) (see Hydromorphone, [[Hydromorphone]])
- Pentazocine (Talwin) (see Pentazocine, [[Pentazocine]])
- Propoxyphene (see Propoxyphene, [[Propoxyphene]])
- Amphetamine (see Amphetamine, [[Amphetamine]])
- Tripelennamine (see Tripelennamine, [[Tripelennamine]])
- Crack Cocaine (see Cocaine, [[Cocaine]]): talc is also commonly used to “cut” injectable crack cocaine
- Heroin (see Heroin, [[Heroin]]): interestingly, foreign body granulomatosis occurs less commonly with heroin abuse, as heroin is typically mixed in soluble fillers (such as quinine, lactose, or maltose)
- Orally-Formulated Drugs of Abuse: talc or starch fillers are commonly used in the intravenous injection of orally-formulated drugs
- Physiologic Consequences of Injected Talc
- Pulmonary Fibrosis and Advanced Emphysema: due to injected talc usually is taken up by interstitium in lungs
- Pulmonary Vascular Inflammation and Secondary Thrombosis: due to embolized talc
IV Injection of Other Particulate Matter
- Etiology: talc or starch fillers are commonly used in the intravenous injection of orally-formulated drugs (like meperidine, methlyphenidate, methadone, dilaudid, talwin, propoxyphene, amphetamines, and tripelennamine)
- Physiologic Consequences of Injected Particulate Matter
- Pulmonary Hypertension: due to occlusion of pulmonary vasculature by injected foreign material (especially cotton fibers)
- Granulomatous Arteritis: due to talc
- Pulmonary Fibrosis and Lung Destruction: due to particles migration through the wall of vessel
Clinical Manifestations
Pulmonary Manifestations
Progressive Massive Fibrosis-Like Conglomerate Lung Masses (see Lung Nodule or Mass, [[Lung Nodule or Mass]])
- Clinical: xxx
Granulomatous Interstitial Lung Disease/Fibrosis (see Interstitial Lung Disease-Etiology, [[Interstitial Lung Disease-Etiology]])
- Diagnosis
- CXR/Chest CT Patterns
- 1-3 mm micronodular infiltrates, mimicking picture seen in pulmonary alveolar microlithiasis
- Upper lobe reticular infiltrates
- Normal: 50% of cases
- Pulmonary Function Tests (PFT’s): decreased DLCO (early indicator)
- Bronchoscopy: lymphocytosis, intracellular and free talc
- Lung Biopsy: granulomas, multinucleated giant cells, mononuclear inflammatory cells, lymphocytes, fibrosis, strongly birefringent crystals using polarzied light (talc) within granulomas
- CXR/Chest CT Patterns
- Clinical
- Dyspnea (see Dyspnea, [[Dyspnea]])
- Treatment
- Corticosteroids (see Corticosteroids, [[Corticosteroids]]): unclear if they are effective
Hilar Lymphadenopathy (see Mediastinal Mass, [[Mediastinal Mass]])
- Clinical: xxx
Advanced Emphysema-Like Picture (see Obstructive Lung Disease, [[Obstructive Lung Disease]])
- Epidemiology
- Diagnosis
- CXR/Chest CT
- Hyperinflation with basilar bullae
- CXR/Chest CT
Granulomatous Pulmonary Arterial Occlusion with Pulmonary Hypertension (see Pulmonary Hypertension, [[Pulmonary Hypertension]])
- Diagnosis
- CXR/Chest CT
- Clinical
- Syncope
- Right-Sided Congestive Heart Failure (CHF)
- Sudden Death
Ocular Manifestations
- Talc Retinopathy (occurs in >50% of cases): talc emboli near macula within small vessels
References
- Am J Roentgenol 2000; Pare, ARRD 1989
- Chest 2000; 118 (1): 258-260
- Intravascular Talcosis due to Intravenous Drug Use Is an Underrecognized Cause of Pulmonary Hypertension. Pulm Med. 2012; 2012: 617531. doi: 10.1155/2012/617531 [MEDLINE]