Cocaine-Induced Ventilation/Perfusion Mismatch Mimicking Pulmonary Embolism

• Published in: JIM - high impact case reports Vol. 8; p. 2324709620906962
• Main Authors: Surapaneni, Phani Keerthi, Abe, Temidayo, Fas, Norberto
• Format: Journal Article
• Language: English
• Published: Los Angeles, CA SAGE Publications 2020; Sage Publications Ltd; SAGE Publishing
• Subjects: Case Report; Case reports; Cocaine; Pulmonary embolisms; Ventilation; pulmonary embolism; cocaine; V/Q scan
• ISSN: 2324-7096; 2324-7096
• DOI: 10.1177/2324709620906962

Pulmonary complications from cocaine use can range from bronchospasm to vasospasm leading to pulmonary infarction. Profound vasospasm may also lead to perfusion defects presenting as pulmonary embolism on ventilation-perfusion scan. A 65-year-old patient with a past medical history of substance abuse and chronic kidney disease presents to the emergency department with sudden-onset chest pain and shortness of breath. Ventilation-perfusion scan revealed filling defect most notably in the lingual lobe. He was later discharged on warfarin for the management of pulmonary embolism. The patient presented to the emergency department 2 weeks later with similar complaints; the international normalized ratio was subtherapeutic, and urine drug screen was positive for cocaine. Repeat ventilation-perfusion scan revealed no filling defects. Follow-up bilateral venous Doppler of lower extremities and D-dimer were within normal limits.