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Radiology of Recreational Drug Abuse¹

¹ From the Departments of Radiology, Bristol Royal Infirmary (I.G.H.) and Southmead Hospital (K.B.), Bristol, England. Presented as an education exhibit at the 2005 RSNA Annual Meeting. Received May 18, 2006; revision requested August 22 and received October 30; accepted October 30. All authors have no financial relationships to disclose. Address correspondence to I.G.H., Department of Radiology, Cheltenham General Hospital, Sandford Road, Cheltenham GL53 7AN, United Kingdom (e-mail: ian_hagan{at}yahoo.com).

Recreational drug abuse is increasing throughout the world. Use of these drugs may result in a diverse array of acute and chronic complications involving almost any body organ, and imaging frequently plays a vital role in detection and characterization of such complications. The nature of the complications depends to a large extent on the drug used, the method of administration, and the impurities associated with the drug. Radiologically demonstrable sequelae may be seen after use of opiates, cocaine, amphetamines and their derivatives such as 3,4-methylenedioxymethamphetamine ("ecstasy"), marijuana, and inhaled volatile agents including amyl nitrite ("poppers") and industrial solvents such as toluene. Cardiovascular complications include myocardial infarction, cardiomyopathy, arterial dissection, false and mycotic aneurysms, venous thromboembolic disease, and septic thrombophlebitis. Respiratory complications may involve the upper airways, lung parenchyma, pulmonary vasculature, and pleural space. Neurologic complications are most commonly due to the cerebrovascular effects of illicit drugs. Musculoskeletal complications are dominated by soft-tissue, bone, and joint infections caused by intravenous drug use. Awareness of the imaging features of recreational drug abuse is important for the radiologist because the underlying cause may not be known at presentation and because complications affecting different body systems may coexist. Intravenous drug abuse in particular should be regarded as a multisystem disease with vascular and infective complications affecting many parts of the body, often synchronously. Discovery of one complication should prompt the radiologist to search for coexisting pathologic conditions, which may alter management.

© RSNA, 2007

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