Other changes: A slice of lung from the left upper lobe (A) and a histologic section from the same area (B) are shown. Look at them carefully and describe the lesions.

A. Hint: The abnormality is related to color.

B. Two abnormalities are present here. Hint: The color of the macrophages is important. What about alveolar size?


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Black pigment is present in a large area in addition to being present around respiratory bronchioles as small spots. While the latter are common in cigarette smokers, large areas of black pigment are not. Also, the air spaces in the blackened areas are slightly enlarged with thin walls--emphysema.

The histologic section shows large numbers of alveolar macrophages with black pigment. A stain for hemosiderin pigment was negative. Air spaces are enlarged compared to normal.

Diagnoses are 1) excess black pigment caused by smoking crack cocaine and 2) focal emphysema.

The photo shows a tube of dusky lavage fluid from another crack smoker.

Pulmonary Complications of Smoking Crack Cocaine

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