Risk factors:
(1) oral tablet containing talc and a drug of abuse (opioid, stimulant, etc)
(2) repeated injections
(3) failure to solubilize or filter the material
Clinical features:
(1) dyspnea on exertion, eventually at rest
(2) chronic cough
(3) deterioration in pulmonary function tests
Imaging findings:
(1) diffuse fine micronodules with ground glass attenuation (microemboli)
(2) pulmonary fibrosis which can become massive
(3) emphysema
(4) pulmonary hypertension
A lung biopsy may demonstrate the talc within blood vessels, macrophages or granulomas.
If there is a right-to-left shunt then talc microemboli can end up in the heart, brain, kidney, eye and skin.
Differential diagnosis:
(1) occupational talcosis
(2) other complications of drug abuse
(3) infection (AIDS, tuberculosis, etc)
(4) complications of smoking
