Pulmonary Granulomas in an Intravenous Drug User

Figure 1. A 28-year-old woman with a history of heroin use was admitted for increasing dyspnea. A chest radiograph (Panel A) showed diffuse bilateral pulmonary infiltrates that were predominantly interstitial. An open-lung biopsy was performed. Histologic analysis showed medial hypertrophy of medium-sized pulmonary arteries indicative of pulmonary hypertension, as well as occasional foreign-body granulomas. Polarized light microscopy (Panel B) revealed refractile particles in the outer portion of the wall of a pulmonary artery (hematoxylin and eosin, ×40). Electron microscopy of lung tissue showed the ultrastructural aspects of the embolized microcrystalline material in an alveolar septum (arrow in Panel C, ×2100; . . .