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Official websites use. Share sensitive information only on official, secure websites. Correspondence to: Edson Marchiori. Fax: 55 21 E-mail: edmarchiori gmail. This is an open-access article distributed under the terms of the Creative Commons Attribution License. We included patients between 19 and 52 years of age. The HRCT scans were evaluated by two radiologists independently, discordant results being resolved by consensus. The inclusion criterion was an HRCT scan showing abnormalities that were temporally related to cocaine use, with no other apparent causal factors. In 8 patients In Among the remaining 14 patients Talcosis, characterized as perihilar conglomerate masses, architectural distortion, and emphysema, was diagnosed in 3 patients. Other patterns were found less frequently: organizing pneumonia and bullous emphysema, in 2 patients each; and pulmonary infarction, septic embolism, eosinophilic pneumonia, and cardiogenic pulmonary edema, in 1 patient each. Pulmonary changes induced by cocaine use are varied and nonspecific. The diagnostic suspicion of cocaine-induced pulmonary disease depends, in most of the cases, on a careful drawing of correlations between clinical and radiological findings. Cocaine is an alkaloid found in the leaves of a bush of the Erythroxylaceae family: the coca bush Erythroxylum coca. Cocaine is the most widely consumed illicit drug among patients treated in emergency rooms, as well as being the leading cause of drug abuse-related deaths. Although there have been some studies reporting cocaine-induced pulmonary changes on chest X-ray CXR , there have been few studies describing CT findings. The objective of the present study was to evaluate, by means of an analysis of HRCT scans of the chest in 22 patients with pulmonary changes that were temporally related to cocaine use, the most common HRCT findings, their morphological characteristics, and the distribution of the lesions in the lung parenchyma. In addition, we studied some epidemiological aspects of those patients. Because the study was retrospective, patient informed consent was not required. This was a descriptive, retrospective observational study of HRCT scans of the chest in 22 patients with pulmonary changes induced by cocaine use, all of which were randomly gathered via personal contacts with radiologists and pulmonologists from seven different institutions, located in six Brazilian states. Eighteen patients were male, and 4 were female. Ages ranged from 19 to 52 years. Patients were assessed for route of cocaine administration, type of cocaine used, and the presence of AIDS. The diagnosis was based on the association between HRCT findings and their temporal relationship with cocaine use, after excluding other possible causes. Among the cases studied, we found patients with different types of pulmonary involvement, presenting with different clinical syndromes caused by cocaine use. In order to group patients and their imaging findings efficiently, we defined a subgroup of 8 patients presenting with features of the 'crack lung' syndrome, which is characterized by respiratory failure associated with pulmonary opacities that are temporally related to crack use, with no other apparent causal factors, and which resolves rapidly after discontinuation of such use. As multiple institutions were involved, the HRCT scans of the chest were obtained with different scanners, using the high-resolution technique, with images being acquired from lung apex to lung base. The scans were evaluated by two radiologists independently, discordant results being resolved by consensus. All scans were analyzed for the following: ground-glass opacities, consolidations, interlobular septal thickening, the crazy-paving pattern, nodules, small parenchymal nodules, centrilobular nodules, the tree-in-bud pattern, cavitation, the halo sign, paraseptal emphysema, apical bullae, bullous emphysema, masses, and architectural distortion. The HRCT findings were also analyzed for laterality bilateral, left, or right , as well as for distribution in the axial plane central, peripheral, or random and in the craniocaudal plane upper, middle, lower, or diffuse. Lesions predominating in the inner third of the lung were defined as central, those predominating in the outer third of the lung were defined as peripheral; and those showing no preferential distribution were defined as random. The craniocaudal distribution of the lesions was characterized as follows: upper, for those located preferably above the level of the aortic arch; middle, for those located from the level of the aortic arch to the level of the carina; lower, for those located below the level of the carina; and diffuse, for those with no apparent predominance. We assessed 22 patients with cocaine-induced pulmonary disease, of whom 18 All patients were adults, and ages ranged from 19 to 52 years mean age of 32 years. The route of cocaine administration was inhalation smokers or 'snorters' , in 19 cases Crack use alone was reported in 9 cases, and other cocaine use, including cocaine hydrochloride and freebase cocaine, was reported in 11 cases. Two patients reported both crack and other cocaine use. The prevalence of AIDS was The clinical and tomographic findings were consistent with the 'crack lung' syndrome in 8 cases. Those changes were clinically divided into acute 'crack lung', barotrauma, pulmonary infarction, septic embolism, and cardiogenic pulmonary edema or chronic talcosis, organizing pneumonia, chronic eosinophilic pneumonia, and bullous emphysema. The crazy-paving pattern was identified in 1 case In another case Paraseptal emphysema in the lung apices was identified in 1 case Although the association of HRCT patterns was common, ground-glass opacities predominated in all cases analyzed. Regarding laterality, the involvement was bilateral in all 8 cases. The axial plane distribution was predominantly peripheral in 5 cases and predominantly central in the remaining 3. In none of the cases was the distribution random. In the craniocaudal plane, lesions were found to predominate in the upper third of the lung in 2 cases and in the lower third of the lung in 2 cases. In addition, diffuse involvement was seen in 4 cases. No case was found to have lesions predominating in the middle third of the lung. Barotrauma was found in 3 patients. Two of those patients reported using cocaine by inhalation, and the other one reported using cocaine by inhalation and injection. Pneumomediastinum Figure 2 , pneumothorax, and spontaneous hemopneumothorax occurred in 1 patient, respectively. Three patients developed talcosis. One of those patients reported using cocaine by inhalation, and the other 2 reported using cocaine by injection. All patients presented with perihilar conglomerate masses associated with architectural distortion and emphysema Figure 3. In 1 of the injection cocaine users, increased density was noted within the masses, whereas, in the other one, there were also small parenchymal nodules in the adjacent parenchyma. Organizing pneumonia was identified in 2 patients. Both of them reported using cocaine by inhalation and had HRCT findings of central and peripheral consolidations associated with architectural distortion. The diagnosis was confirmed by lung biopsy. Bullous emphysema was found in 2 patients who smoked cocaine, 1 of whom reported both cocaine and marijuana use. In that patient, HRCT showed large emphysema bullae in the lung apices, associated with architectural distortion. One patient developed pulmonary infarction and reported using cocaine by inhalation. The HRCT scan of that patient showed triangular subpleural consolidation with a pleural base. The diagnosis of pulmonary infarction was based on the clinical condition of the patient in combination with the radionuclide imaging pattern. The patient with HRCT findings consistent with septic embolism reported using cocaine by injection. In that case, the HRCT findings consisted of predominantly peripheral pulmonary nodules, most of which were cavitated Figure 4. Cardiogenic edema was identified in 1 patient, who reported using cocaine by inhalation. The HRCT scan of that patient showed ground-glass opacities interspersed with smooth interlobular septal thickening, resulting in a crazy-paving pattern, associated with bilateral pleural effusion and an enlarged cardiac silhouette. The patient with eosinophilic pneumonia reported using crack by inhalation. He presented with peripheral and pulmonary eosinophilia. His HRCT scan showed peripheral areas of ground-glass attenuation. Cocaine is the second most widely used illicit drug second only to marijuana in Brazil and in the world, as well as being associated with numerous health problems, such as those related to the respiratory system. For this reason, few case series have been published on the topic, being primarily limited to the study of the profile of cocaine users and their symptoms, especially those associated with psychological and behavioral changes. Because of the pulmonary impairment observed in cocaine users, chest radiology plays a critical role in the assessment of such patients. Large prospective studies aimed at the radiological investigation of pulmonary changes are scarce and limited to CXR series. Regarding the profile of cocaine users in Brazil and in South America, the incidence of use is higher in males in the to year age group. Currently, the most widely used form of cocaine is crack, mainly because of its intense euphoric effects, which are obtained within a few minutes, and its lower cost. In Brazil, at least two other varieties of freebase cocaine, designated 'merla' and 'oxi', are administered by inhalation smoked. There is a relationship between cocaine use and the presence of HIV infection and AIDS 5 ; this is due to increased exposure to risky sexual behavior and to transmission via injection drug use. The diagnosis of cocaine-induced pulmonary impairment is based primarily on a history of exposure to cocaine, consistent radiological findings, and the exclusion of other apparent causes for those findings. Certain physical examination findings, such as burned fingertips, resulting from handling the glass pipes typically used to smoke the drug, or the presence of black sputum, characteristic of crack use and attributed to the inhalation of carbon residues from butane or from the alcohol-soaked cotton used for the purpose of cooking the cocaine, can suggest the diagnosis. The frequency of cocaine-induced pulmonary complications is unknown; however, a wide spectrum of changes have been described in literature reviews. In our study, the HRCT scans of 22 patients were evaluated, and the most common finding was 'crack lung', in 8 cases, followed by barotrauma and talcosis, in 3 cases each. Other findings included organizing pneumonia and bullous emphysema, in 2 cases each. In addition, pulmonary infarction, septic embolism, cardiogenic edema, and eosinophilic pneumonia were identified in one case each. It should be considered, however, that no radiological finding alone is diagnostic of pulmonary changes induced by cocaine use. Most imaging findings are nonspecific and should be correlated with a history of cocaine use. The term 'crack lung' refers to an acute pulmonary syndrome that occurs after inhalation of freebase cocaine and is associated with fever, hypoxemia, hemoptysis, respiratory failure, and the presence of diffuse alveolar infiltrates rich in eosinophils. HRCT findings in patients with 'crack lung' include ground-glass opacities, consolidations, airspace nodules, smooth interlobular septal thickening, and, in some cases, the crazy-paving pattern. In our study, a bilateral distribution was found in all cases, being predominantly peripheral in the axial plane and diffuse in the craniocaudal plane. Barotrauma is another complication that is often related to crack smoking and to the inhalation of powdered cocaine. In our study, we found 3 cases of barotrauma, 1 case of pneumomediastinum, and 2 cases of pneumothorax, 1 of which was associated with hemothorax. Talc, silica, cellulose, and other adulterants are added to street cocaine. In 1 case, increased density was noted within the masses, and, in another one, there were also small nodules in the adjacent parenchyma. Organizing pneumonia has been reported in young crack smokers. Septic pulmonary embolism and community-acquired pneumonia are among the most commonly observed infectious pulmonary complications in i. Our study had some limitations. First, the study was retrospective. Second, HRCT techniques varied widely, given the multicenter origin of the cases studied. Another important limitation of the present study, as well as of any other study related to drug users, is that, in certain cases, there are difficulties in establishing a causal relationship between cocaine use and HRCT patterns with certainty. Many of those individuals used or use other illicit drugs by inhalation or i. Therefore, when crushed and injected into a peripheral vein, oral use tablets can also cause pulmonary talcosis. In other cases, the added use of marijuana can cause pulmonary bullous lesions. Despite these limitations, the present study includes the largest series of patients with cocaine-induced pulmonary changes identified on HRCT scans that has ever been published. In conclusion, the most frequently found type of pulmonary change was 'crack lung'. Other highly prevalent thoracic complications related to cocaine use were barotrauma and talcosis, followed by bullous emphysema and organizing pneumonia, as well as by cases of pulmonary infarction, septic embolism, cardiogenic pulmonary edema, and eosinophilic pneumonia. Pulmonary changes induced by cocaine use are nonspecific and should be temporally correlated with such use, after exclusion of other causes. As TCAR foram avaliadas por dois radiologistas, de forma independente, e os casos discordantes foram resolvidos por consenso. Dezoito pacientes eram do sexo masculino e 4 eram do sexo feminino, com idades variando de 19 a 52 anos. Os exames foram avaliados por dois observadores, de forma independente, e os resultados discordantes foram resolvidos por consenso. Barotrauma foi encontrado em 3 pacientes. As a library, NLM provides access to scientific literature. J Bras Pneumol. View full-text in Portuguese. Find articles by Renata Rocha de Almeida. Find articles by Arthur Soares Souza Jr. Find articles by Luciana Soares de Souza. Find articles by Jorge Luiz Pereira e Silva. Find articles by Dante Luiz Escuissato. Find articles by Klaus Loureiro Irion. Find articles by Luiz Felipe Nobre. Find articles by Bruno Hochhegger. Find articles by Edson Marchiori. Open in a new tab. Financial support: None. Issue date Jul-Aug. PMC Copyright notice. Apoio financeiro: Nenhum. Similar articles. Add to Collections. Create a new collection. Add to an existing collection. Choose a collection Unable to load your collection due to an error Please try again. Add Cancel.

DASSA Monograph No 23 - 2007

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Official websites use. Share sensitive information only on official, secure websites. The manuscript has been read and approved by all authors, and there are no other persons who satisfied the criteria for authorship and hence are not listed. The order of authors listed in the manuscript has been approved by all of us. This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Even though jazz is a musical style that excels in improvisation and virtuosity, it is not without its share of anecdotes, drama, and downright tragedy, and the biographies of jazz musicians and their demise are fraught with ominous and dire straits. Unsurprisingly, some would develop chronic and fatal diseases. The neurological diseases that afflicted the following six composers and musicians, all of whom are considered jazz legends, are briefly discussed: Charles Mingus, diagnosed with amyotrophic lateral sclerosis; Lester Young and Charlie Parker, both diagnosed with neurosyphilis; Thelonius Monk, who had possible frontotemporal dementia; George Gershwin, who died as a result of brain glioma; and Cole Porter, who developed phantom limb pain following an amputation. The association of lifestyles, with drug abuse, particularly alcohol and heroin, in addition to great sexual promiscuity factors contributed to the development of a series of diseases such as syphilis. In addition, we also described some fatalities such as neurodegenerative diseases and cerebral glioma. This new phenomenon had its roots in the blues, a form of folk music created by African Americans, and ragtime, a black version of European piano music 1 , 2. Jazz would reach its heyday in the second half of the 20th century, initially in the USA. During this period, it existed in various forms and was being performed and written by great musicians and composers, some of whom became jazz legends 1 , 2 , 3. The purpose of this review was to briefly discuss the neurological diseases that affected a select group of jazz musicians and composers, some due to their lifestyles and some due to fatality. Charles Mingus — Figure 1A was a jazz composer and a gifted double bassist. During his career, he received distinctions from various institutions, such as the National Endowment for the Arts, the Smithsonian Institute, the Guggenheim Foundation, and Yale University 4 , 5 , 6. In the s, Mingus experienced progressive lower limb weakness associated with muscle atrophy; in , the diagnosis was done for amyotrophic lateral sclerosis ALS 3 , 4 , 5 , 6. He worsened progressively and used a wheelchair until his death in 3 , 4 , 5 , 6. Thelonius Sphere Monk — Figure 1B was considered an innovator and the founder of bebop, a new type of jazz 6 , 7. He was a frequent consumer of alcohol and hallucinogenic drugs, particularly heroin, leading to his arrest and banishment from performing in New York City for 6 years 3 , 6 , 7. There is clear evidence that Monk had depressive behavior, developing progressive mental confusion intermingled with episodes of intense restlessness and excitement, followed by periods of depression, apathy, and mutism; in the s, he was admitted to a psychiatric hospital in San Francisco, California 3 , 6 , 7. In retrospect, the possible diagnoses could be bipolar disorder and frontotemporal dementia FTD , starting with behavioral disorder followed by language disorder and subsequent dementia. Another possibility is cerebrovascular disease secondary to substance abuse 3 , 6 , 7. In , Monk suffered a stroke and died; the diagnosis with a ruptured cerebral aneurysm was questioned but never confirmed 3. In , Breitenfeld et al. Young also had a history of coronary insufficiency and cognitive impairment with confirmed neurosyphilis 3 , 6 , 8 , 9. He had a history of alcohol and heroin abuse with previous diagnoses of cirrhosis, upper gastrointestinal bleeding, and myocardial infarction 3 , 6 , 8 , 9 , Following a review of his medical records and based on the presence of behavioral and dementia disorders, as well as a positive Wasserman test, Parker was diagnosed with neurosyphilis 3 , 6 , 8 , 9 , As his condition progressed, Gershwin experienced severe headaches associated with episodes of dizziness and behavioral disorders, developing signs and symptoms of intracranial hypertension before going into coma 6 , 11 , 12 , 13 , 14 , After his admittance to a hospital in , ancillary tests revealed a cystic tumor with a mural nodule extending deeply into brain tissue. Despite urgent neurosurgery, he died in the immediate postoperative period; neuropathology confirmed the diagnosis with glioblastoma multiforme 6 , 11 , 12 , 13 , 14 , Cole Porter — Figure 1F came from a very wealthy family and studied at Yale and Harvard 13 , He remains one of the most outstanding composers the USA has produced 6 , 13 , In , Porter fell from a horse and fractured his both femurs, leading to bacterial infection and consequent osteomyelitis; despite 33 operations, his staphylococcal osteomyelitis chronified 6 , 13 , He abused alcohol and narcotics because of the chronic pain and, in , his right lower limb was amputated. He subsequently began to experience pain in the amputated limb and was diagnosed with phantom limb pain 6 , 13 , Porter died in from chronic renal failure 3 , 13 , Psychiatry in the days of these jazzmen was mainly asylum-centered 3. Mentally ill patients were institutionalized for life, as therapeutic prospects were neglected; the epidemics of neurosyphilis and alcoholism contributed to an increase in the number of patients locked in these facilities. Academic advancements in the field of psychiatry occurred in this period. Psychopharmacology remained incipient, but synthesis and clinical application of several compounds, such as bromides , chloral , barbiturates , antihistamines , and lithium , were described until the s. Other unusual treatment options of the time included infecting patients with malaria to treat neurosyphilis and inducing insulin coma to treat schizophrenia. Although substance abuse first opium, chloral, and barbiturates, and later heroin presented a vertiginous increase during the 19th and 20th centuries, it was not recognized as a relevant public health issue It remains undisclosed if jazz musicians — or musicians in general — are more prone to neurological disease than the general population; their hedonistic lifestyle might have epigenetically contributed to genetically driven neurodegeneration. In this historical review, the neurological diagnoses of six jazz composers and musicians were briefly discussed. The association of lifestyles, with drug abuse, particularly alcohol and heroin, in addition to great sexual promiscuity factors contributed to the development of a series of diseases, such as syphilis. In addition, we also described some fatalities: neurodegenerative diseases, such as ALS and frontotemporal dementia, and a case of cerebral glioma. As a library, NLM provides access to scientific literature. Arq Neuropsiquiatr. Show available content in en pt. Find articles by Francisco Manoel Branco Germiniani. Find articles by Carlos Henrique Ferreira Camargo. Conflict of interest: There is no conflict of interest to declare. PMC Copyright notice. Open in a new tab. Similar articles. Add to Collections. Create a new collection. Add to an existing collection. Choose a collection Unable to load your collection due to an error Please try again. Add Cancel.

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