Rapid development of pulmonary hypertension and right ventricular failure due to large vessel intravascular microcrystalline cellulosis in an intravenous drug user.

Intravascular foreign body deposition in the form of talc or microcrystalline cellulose is an uncommon but increasing cause of pulmonary hypertension given the current opioid epidemic. Earlier cases describe the effect of talc introduced via intravenous injection of crushed pills when deposited throughout the lungs, typically in the capillaries or distal pulmonary arterioles. An angiogranulomatous reaction ensues with pulmonary vascular remodeling and the gradual development of pulmonary hypertension.