Opioid Crisis Increases Cardiothoracic Complications in Young Adults

An estimated 130+ people die each day from opioid– related drug overdose caused by a list of substances ranging from illegal drugs such as heroin and fentanyl to medications like oxycodone, morphine, codeine and others available legally through prescription.

According to researcher Anna Bader, MD, assistant professor of radiology and biomedical imaging at Yale School of Medicine, the opioid problem lies at the intersection of many different fields including psychiatry, psychology, addiction, pain management, cardiology and law, among others.

In a study shared at RSNA 2019, Dr. Bader said she and her colleagues noted an increase in the number of patients in their 20s and 30s presenting with cardiac complications normally rare in their age categories.

“Every day we see patients who are so young, and we look at their charts and find that they are like us,” Dr. Bader said. “They are our age, are from our towns, have relatable jobs and kids like ours, and they are really fighting for their lives.” 

Dr. Bader’s research included a review of 13 different cases focusing on aspiration-related and injection-related presentations.

According to Dr. Bader, aspiration and lipoid pneumonias are commonly seen in patients who may have altered mental status, respiratory depression and poor dental hygiene.

“Lipoid pneumonia can sometimes come when patients aspirate vegetable, animal or mineral oils while using fentanyl lollipops to manage pain over an extended period of time,” she said.

She highlighted the importance of looking at airways for aspirations and occlusions and presented CT imaging of an aspirated pill in the lung of a patient with chronic back pain and a history of opioid abuse.

According to Dr. Bader, there are also significant instances of injection-related problems. One case highlighted the degree to which patients who abuse IV drugs may self-sabotage their own care.

A young patient presented with talcosis after crushing oxycodone pills and injecting them into his peripherally inserted central catheter. Lung imaging for the patient revealed diffuse fine micronodules, centrilobular ground glass nodules, ground-glass opacities and high-attenuation progressive massive fibrosis.

“We often see patients presenting with multiple problems,” she said. “They are difficult to treat and have significant risk for re-infection.”

Dr. Bader noted that IV drug use, must be considered along with risk factors for septic emboli and is involved in the development of sarcoid-like reactions, cases of endocarditis, aortic valve vegetations and many other problems.

She added that additional consideration must be given to the spread of infection to the bones hematogeneously or through the skin and highlighted a case of a 55-yearold patient with a history of IV drug and fentanyl use. MRI performed on the patient revealed a septic right shoulder that was found positive for beta-hemolytic streptococcus group G.

“We use the same imaging modalities yet see a different spectrum of the disease, a very different presentation,” Dr. Bader said. “Although addiction is not primarily a radiologic diagnosis, radiologists need to keep our awareness of opioid abuse at the front of our differential diagnosis with anyone that might fit the bill — both new and existing patients.”

Learn more about radiologists role in caring for patients with a history of opioid abuse in a video interview with Dr. Bader at RSNA 2019: