Inhalation of crack cocaine can mimic pulmonary embolism

Inhaled cocaine has been associated with a number of pulmonary manifestations including pulmonary edema, hypersensitivity pneumonitis, bronchospasm, obliterative bronchiolitis, alveolar hemorrhage, and pneumomediastinum. However, the effects of cocaine on pulmonary vasculature have been poorly described. The authors report a patient with a history of cocaine inhalation presenting with high clinical suspicion for pulmonary embolism and a high probability ventilation-perfusion lung scan. A pulmonary angiogram revealed no pulmonary embolism. The authors believe this syndrome was caused by intense pulmonary artery vasospasm secondary to cocaine inhalation. A pulmonary angiogram may be required to establish the correct diagnosis and avoid unnecessary anticoagulation in such patients.