HSS Journal ®

, Volume 15, Issue 1, pp 76–83 | Cite as

Systemic Complications and Radiographic Findings of Opioid Use and Misuse: An Overview for Orthopedic Surgeons

  • Harry G. GreditzerIV
  • Dustin H. Massel
  • Carlos M. Barrera
  • Nisreen S. Ezuddin
  • Christopher P. EmersonEmail author
  • Jean Jose


Amid growing concern about the misuse of prescribed opioids, the rising rates of opioid use disorder, and the use of illicit opioids, clinicians in ambulatory, inpatient, and operative environments are encountering opioid-related complications in their patients. These complications can affect multiple organ systems including cardiovascular, pulmonary, gastrointestinal, and neurologic and are related to excess opioid levels in the body or contamination from non-sterile injection. It is important for the orthopedic surgeon to have a general understanding of the pathologies associated with opioid use disorder and their appearance on diagnostic imaging. This article reviews image findings of several complications, organized in a systems-based approach, for the orthopedic surgeon.


opioids diagnostic imaging complications of opioid use infective endocarditis arterial/mycotic pseudoaneurysm noncardiogenic pulmonary edema 


Compliance with Ethical Standards

Conflict of Interest

Harry G. Greditzer IV, MD, Dustin H. Massel, MD, Carlos M. Barrera, BS, Nisreen Ezuddin, BS, Christopher P. Emerson, MS, and Jean Jose, DO, MS, declare that they have no conflict of interest.

Human/Animal Rights

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2013.

Informed Consent

Informed consent was waived from all patients for being included in this review.

Required Author Forms

Disclosure forms provided by the authors are available with the online version of this article.

Supplementary material

11420_2018_9649_MOESM1_ESM.pdf (1.2 mb)
ESM 1 (PDF 1224 kb)
11420_2018_9649_MOESM2_ESM.pdf (1.2 mb)
ESM 2 (PDF 1224 kb)
11420_2018_9649_MOESM3_ESM.pdf (1.2 mb)
ESM 3 (PDF 1224 kb)
11420_2018_9649_MOESM4_ESM.pdf (1.2 mb)
ESM 4 (PDF 1224 kb)
11420_2018_9649_MOESM5_ESM.pdf (1.2 mb)
ESM 5 (PDF 1224 kb)
11420_2018_9649_MOESM6_ESM.pdf (1.2 mb)
ESM 6 (PDF 1224 kb)


  1. 1.
    Agha A, Al-Hakami M. A case report of pseudo-subarachnoid hemorrhage. Maedica (Buchar). 2011;6(3):210–212.Google Scholar
  2. 2.
    Bates DDB, et al. Acute radiologic manifestations of America’s opioid epidemic. Radiographics. 2018;38(1):109–123.CrossRefGoogle Scholar
  3. 3.
    Benyamin R, Trescot AM, Datta S, et al. Opioid complications and side effects. Pain Physician. 2008;11(2 Suppl):S105–120.Google Scholar
  4. 4.
    Boland JW, Boland EG. Pharmacological therapies for opioid induced constipation in adults with cancer. BMJ. 2017;358:j3313.CrossRefGoogle Scholar
  5. 5.
    Boom M, Niesters M, Sarton E, Aarts L, Smith TW, Dahan A. Non-analgesic effects of opioids: opioid-induced respiratory depression. Curr Pharm Des. 2012;18(37):5994–6004.CrossRefGoogle Scholar
  6. 6.
    Buttner A, Weis S. Neuropathological alterations in drug abusers : the involvement of neurons, glial, and vascular systems, Forensic Sci Med Pathol. 2006;2(2):115–126.CrossRefGoogle Scholar
  7. 7.
    Carmelli G, Surles T, Brown A. Endophthalmitis and mycotic aneurysm: the only clues to underlying endocarditis. Clin Pract Cases Emerg Med. 2018;2(1):16–20.CrossRefGoogle Scholar
  8. 8.
    Chaudhry AA GM, Baker KS, Gould ES. Radiologic manifestations of recreational drug abuse. Contemp Diagn Radiol. 2016;39(4):1–8.CrossRefGoogle Scholar
  9. 9.
    Chou DW, Wu SL, Chung KM, Han SC, Cheung BM. Septic pulmonary embolism requiring critical care: clinicoradiological spectrum, causative pathogens and outcomes, Clinics (Sao Paulo). 2016;71(10):562–569.CrossRefGoogle Scholar
  10. 10.
    Dublin S, Walker RL, Jackson ML, et al. Use of opioids or benzodiazepines and risk of pneumonia in older adults: a population-based case-control study. J Am Geriatr Soc. 2011;59(10):1899–1907.CrossRefGoogle Scholar
  11. 11.
    Frank RG, Pollack HA. Addressing the fentanyl threat to public health. N Engl J Med. 2017;376(7):605–607.CrossRefGoogle Scholar
  12. 12.
    Hartman L, Barnes E, Bachmann L, Schafer K, Lovato J, Files DC. Opiate injection-associated infective endocarditis in the Southeastern United States. Am J Med Sci. 2016;352(6):603–608.CrossRefGoogle Scholar
  13. 13.
    Hidalgo A, Franquet T, Gimenez A, Bordes R, Pineda R, Madrid M. Smoking-related interstitial lung diseases: radiologic-pathologic correlation. Eur Radiol. 2006;16(11):2463–2470.CrossRefGoogle Scholar
  14. 14.
    Hill MD, Cooper PW, Perry JR. Chasing the dragon—neurological toxicity associated with inhalation of heroin vapour: case report. CMAJ. 2000;162(2):236–238.Google Scholar
  15. 15.
    Lee TH, Lee JS, Hong SJ, et al. Risk factors for postoperative ileus following orthopedic surgery: the role of chronic constipation. J Neurogastroenterol Motil. 2015;21(1):121–125.CrossRefGoogle Scholar
  16. 16.
    Manchikanti L, Singh A. Therapeutic opioids: a ten-year perspective on the complexities and complications of the escalating use, abuse, and nonmedical use of opioids, Pain Physician. 2008;11(2 Suppl):S63–S88.Google Scholar
  17. 17.
    Moreillon P, Que YA, Bayer AS. Pathogenesis of streptococcal and staphylococcal endocarditis. Infect Dis Clin North Am. 2002;16(2):297–318.CrossRefGoogle Scholar
  18. 18.
    Ogilvie WH. William Heneage Ogilvie 1887–1971. Large-intestine colic due to sympathetic deprivation. A new clinical syndrome. Dis Colon Rectum. 1987;30(12):984–987.CrossRefGoogle Scholar
  19. 19.
    Peroš-Golubičić T, Sharma O. Drug addict’s lung. Clinical Atlas of Interstitial Lung Disease. London: Springer; 2006.Google Scholar
  20. 20.
    Pizzi LT, Toner R, Foley K, et al. Relationship between potential opioid-related adverse effects and hospital length of stay in patients receiving opioids after orthopedic surgery. Pharmacotherapy. 2012;32(6):502–514.CrossRefGoogle Scholar
  21. 21.
    Radke JB, Owen KP, Sutter ME, Ford JB, Albertson TE. The effects of opioids on the lung. Clin Rev Allergy Immunol. 2014;46(1):54–64.CrossRefGoogle Scholar
  22. 22.
    Roy S, Ninkovic J, Banerjee S, et al. Opioid drug abuse and modulation of immune function: consequences in the susceptibility to opportunistic infections. J Neuroimmune Pharmacol. 2011;6(4):442–465.CrossRefGoogle Scholar
  23. 23.
    Saunders MD. Acute colonic pseudoobstruction. Curr Gastroenterol Rep. 2004;6(5):410–416.CrossRefGoogle Scholar
  24. 24.
    Schaaf JT, Spivack ML, Rath GS, Snider GL. Pulmonary edema and adult respiratory distress syndrome following methadone abuse. Am Rev Respir Dis. 1973;107(6):1047–1051.Google Scholar
  25. 25.
    Soelberg CD, et al. The US opioid crisis: current federal and state legal issues. Anesth Analg. 2017;125(5):1675–1681.CrossRefGoogle Scholar
  26. 26.
    Vanek VW, Al-Salti M. Acute pseudo-obstruction of the colon (Ogilvie’s syndrome). An analysis of 400 cases. Dis Colon Rectum. 1986;29(3):203–210.CrossRefGoogle Scholar
  27. 27.
    Yin R, Lu C, Chen Q, Fan J, Lu J. Microvascular damage is involved in the pathogenesis of heroin induced spongiform leukoencephalopathy. Int J Med Sci. 2013;10(3):299–306.CrossRefGoogle Scholar

Copyright information

© Hospital for Special Surgery 2018

Authors and Affiliations

  1. 1.Department of RadiologyHospital for Special SurgeryNew YorkUSA
  2. 2.UHealth Sports Medicine InstituteUniversity of Miami Miller School of MedicineMiamiUSA
  3. 3.Department of RadiologyJackson Memorial HospitalMiamiUSA

Personalised recommendations