New diffuse groundglass opacification of the bilateral lungs, with
tiny centrilobular nodules. Normal cardiac silhouette. The differential diagnosis includes viral
pneumonia, PCP, pulmonary hemorrhage, pulmonary edema, and pulmonary
alveolar proteinosis.

1. Diffuse bilateral alveolar groundglass opacities with interlobular
and intralobular thickening, which may represent ARDS, bacterial
pneumonia, or pulmonary alveolar proteinosis (PAP). Recommend
followup when the patient's symptoms have improved to document
resolution.
2. Mediastinal and right hilar lymphadenopathy, which is nonspecific,
but may represent a reactive or infectious etiology.

secondary to crack cocaine

typically develop in 1-48hr

Most common are edema due to increased capillary permeability and alveolar hemorrhage

also watch for severe barotrauma from valsalva and bronchoconstriction in preexisting asthma patients

cocaine users unable to kill bacteria with macrophages and nitric oxide, increasing risk of pulmonary infection

Endothelin (ET-1) also increased and possibly a measure of alveolar damage

hemoptysis absent in 33%

For drug-induced DAH, in addition to cessation of the culprit drug, we suggest systemic glucocorticoid therapy due to the severity of the disease and the histopathologic observation of inflammation in some patients (Grade 2C).

weak, observational recomm