Radiologic Manifestations of the Opioid Epidemic

Targeted CE per ARRT’s Discipline, Category, and Subcategory classification:
[Note: Discipline-specific Targeted CE credits may be less than the total Category A credits approved for this course.]

Computed Tomography: 1.00
Procedures: 1.00
Head, Spine, and Musculoskeletal: 0.25
Neck and Chest: 0.50
Abdomen and Pelvis: 0.25

Magnetic Resonance Imaging: 2.00
Image Production: 0.25
Data Acquisition, Processing, and Storage: 0.25
Procedures: 1.75
Neurological: 0.75
Body: 0.75
Musculoskeletal: 0.25

Registered Radiologist Assistant: 1.75
Procedures: 1.75
Abdominal Section: 0.50
Thoracic Section: 0.25
Musculoskeletal and Endocrine Sections: 0.25
Neurological, Vascular, and Lymphatic Sections: 0.75

Outline

1. Introduction
2. Neuroradiologic Manifestations
   1. Cerebral Septic Emboli
   2. Cerebritis, Brain Abscess, and Ventriculitis
   3. Mycotic Aneurysm
   4. Heroin-induced Leukoencephalopathy
   5. Hypoxic Ischemic Injury
3. Cardiopulmonary Manifestations
   1. Infective Endocarditis
   2. Septic Pulmonary Emboli
   3. Pulmonary Artery Mycotic Aneurysm
   4. Noncardiogenic Pulmonary edema and Acute Lung Injury
4. Musculoskeletal Manifestations
   1. Soft-Tissue Infections
   2. Retained Needle Fragments
   3. Rhabdomyolysis and Overdose
5. Abdominal Manifestations
   1. Intracorporeal Concealment of Drugs
   2. Embolic Infarcts in Abdominal Viscera
   3. Mycotic Aneurysm of the Superior Mesenteric Artery
6. Conclusion

Objectives

Upon completion of this course, students will:

1. state the number of opioid overdose deaths in 2015
2. list the areas of the body where cross-sectional imaging helps determine pathology
3. recall possible complications associated with dislodgement of infected cardiac vegetations followed by intracranial vessel occlusion
4. discuss the Wilbring et al. study of 495 patients
5. choose which MR sequence is most sensitive for the detection of hyperintensity in the subarachnoid spaces
6. state the portion of the body that preserves the blood-brain barrier
7. list the stages of abscess development
8. describe pyogenic ventriculitis
9. list the reasons why drug abusers lick the needle before using it for injection
10. recall the amount of intravenous drug users that admit to licking the needle prior to injecting drugs
11. state the modality of choice for imaging mycotic aneurysm
12. recognize the possible complications to vessel rupture due to aneurysm
13. state the mortality rate associated with a ruptured mycotic aneurysm
14. recall the moniker associated with heroin-induced leukoencephalopathy
15. state the imaging modality that most conspicuously identifies the acute phase of toxic encephalopathy
16. discuss imaging pitfalls and findings that emergency radiologists should be familiar with in the setting of opioid overdose patients
17. state the increase in the estimated incidence of infective endocarditis in the general population
18. chose the imaging procedure that should be utilized for initial evaluation of clinically suspected infective endocarditis
19. recall the imaging procedure that has the highest sensitivity for the detection of native valve endocarditis
20. list the clinical symptoms of septic pulmonary emboli
21. list the most common CT features of septic pulmonary emboli
22. recall the mortality rate for patients with pulmonary artery mycotic aneurysm
23. describe how pulmonary artery mycotic aneurysms are managed
24. explain the term “pocket shot”
25. state the most common reason for hospital admission of intravenous drug users
26. list areas in the body where needle fragments may be found
27. state the possible cause of cardiac rhabdomyolysis
28. describe “body-packer syndrome”
29. explain where packaged drugs may be concealed within the body
30. list the areas of the body that may be affected by the release of septic emboli associated with left-sided endocarditis