Also throughout the lung you see diffuse nodularity.

What type of inflammation do you see?

What is it in response to? Could it be related to the prior pathology?

What agent(s) might have caused this type of reaction?

The chronic inflammation here is in the form of loosely formed granulomas (non-caseating) with numerous multinucleated giant cells (fused macrophages). Non-caseating granulomas occur in a number of diseases (sarcoidosis, inflammatory bowel disease, leprosy), or as in this case, in response to indigestible foreign material (e.g. talc). The response consists of mainly lymphocytes, macrophages, and fibroblasts (no neutrophils). Look closely and you can see the foreign material in the multinucleated macrophages. This material is birefringent when observed using polarized light. In this patient, the reaction was caused by the inhalation of foreign material along with crack cocaine. A similar pattern is seen in patients that inject street drugs intravenously. This represents one form of "crack lung;" the other has an associated asthmatic component.

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