Carbon-laden macrophages in pleural fluid of crack smokers

Diagn Cytopathol. 1995 Nov;13(4):316-9. doi: 10.1002/dc.2840130408.


Carbon-laden macrophages in bronchoalveolar lavage have been noted to be associated with a history of crack smoking. We report herein the finding of carbon-laden macrophages in four cytological preparations of pleural fluid from two crack smokers. The etiology of the two patients' pleural effusions differed; neither had a bronchopleural fistula. Patient 1 had AIDS, Pneumocystis carinii pneumonia, and Kaposi's sarcoma of the right lung with an associated bilateral pleural effusion. Patient 2 was HIV seropositive, had pulmonary tuberculosis, hepatitis A, B, and C, cardiomyopathy, pulmonary embolism, and bilateral pleural effusions, the latter of which were probably due to cardio-pulmonary dysfunction. An additional two crack smokers with pleural effusions due to malignancy, one primary pulmonary adenocarcinoma and the other metastatic melanoma, did not have carbon-like material in their pleural fluid cytology. We hypothesize that intracellular accumulation of carbonaceous material in the lung parenchyma and pleural space occurs when normal clearance mechanisms are overwhelmed.

Publication types

  • Case Reports

MeSH terms

  • Acquired Immunodeficiency Syndrome / complications
  • Adult
  • Carbon / analysis*
  • Cardiomyopathies / complications
  • Crack Cocaine / administration & dosage
  • Crack Cocaine / adverse effects*
  • HIV Seropositivity / complications
  • Hepatitis A / complications
  • Hepatitis B / complications
  • Hepatitis C / complications
  • Humans
  • Lung Neoplasms / complications
  • Macrophages / chemistry*
  • Male
  • Middle Aged
  • Pleural Effusion / etiology
  • Pleural Effusion / pathology*
  • Pneumonia, Pneumocystis / complications
  • Sarcoma, Kaposi / complications
  • Smoking
  • Tuberculosis / complications


  • Crack Cocaine
  • Carbon