LearningRadiology - Crack Cocaine Abuse

Crack Cocaine Abuse

“Crack” or “rock” is prepared by mixing cocaine hydrochloride, which is the preparation usually available on the street, with an alkaline solution such as baking soda. The mixture may be heated directly until it vaporizes, but this form contains impurities.

Freebase cocaine can be prepared by adding a solvent, such as ether, to the mixture. The mixture separates into two layers with the top layer containing freebase cocaine dissolved in the solvent. The solvent layer is then separated either by filter or, less commonly today, by evaporating it at low temperatures to leave pure alkaloid cocaine crystals. The product is then smoked.

Clinical

Shortness of breath
Cough
Production of black sputum (2° carbonaceous materials in smoke)
Hemoptysis
Chest pain

X-ray

Non-cardiogenic pulmonary edema (“increased permeability”)
Most likely 2° to damage to capillary membrane, either by

Direct toxic effect on capillary endothelium
Intense vasoconstrictor effect leads to anoxic cell damage

Bronchiolitis obliterans with organizing pneumonia (BOOP)
Pulmonary infiltrates with eosinophilia

Adulterants have been implicated in producing hypersensitivity rx

Lidocaine, lactose, sucrose, starch and talc

Pulmonary hemorrhage

Either from anoxic cell damage 2° vasoconstriction or direct toxic effect

Diffuse Interstitial Pneumonia
Pneumothorax
Pneumoperitoneum

Both 2° extended Valsalva maneuver to enhance drug’s effect

WH/92