Skip to content

Assembly

It’s Just Water Vapor

Author
Jacob Kaslow, MD
Pediatric Pulmonary Fellow, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN


Case

A 16-year-old female with history of obesity, scoliosis and ½ pack-per-day tobacco smoking history for the past two years presented with acute onset of cough, shortness of breath and headache associated with perioral cyanosis. Despite escalating respiratory support and broad-spectrum antibiotics, she ultimately required intubation and subsequent placement onto extracorporeal membrane oxygenation (ECMO). All infectious and rheumatologic disease workup was negative and she responded well to high dose steroids. A bronchoscopy was notable for diffuse, bilateral mucus plugging and bronchoalveolar lavage fluid showed 77% macrophages, 11% neutrophils, 8% eosinophils, 3% basophils and 1& lymphocytes, although this was obtained while on steroids. Her initial chest radiograph (Image 1) and representative slice of her chest CT scan (Image 2) are shown below:

Chest CT scan

Question

Based on presentation and imaging, which of the following aspects of her history would provide the most insight towards underlying etiology?

A. History of recent electronic cigarette use
B. Recent travel
C. Contact with an individual recently incarcerated
D. Recent trauma

Answer