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Classic CT chest findings of an adolescent with EVALI

Authors
Zachary Johnson, DO, Ann & Robert Lurie Children's Hospital, Northwestern University
Terri Laguna, MD, Ann & Robert Lurie Children's Hospital, Northwestern University


Case

A 14-year-old young man with a remote history of asthma and allergic rhinitis presented to the Emergency Room with a five-day history of cough, fever, abdominal pain and chest pain. On arrival to the emergency department he was febrile to 38.1 degrees and tachycardic to 108 breaths per minute. He was breathing 20 breaths per minute and saturating 95% on room air. He appeared comfortable and had a normal lung exam. Initial diagnostic workup included a CBC with a leukocytosis to 17.6 and 91.8% neutrophil predominance. He had elevated inflammatory markers with a CRP of 27.8 mg/dl (normal <0.8), ESR of 72 mm/hr (normal <20) and procalcitonin of 0.29 ng/ml (normal <0.1). CMP was unremarkable and NT-ProBNP was elevated at 194 pg/ml (normal <125). Initial chest x-ray showed non-specific medial and basal lung opacities. Given the abdominal pain and fever, an abdominal and pelvic CT scan was performed revealing diffuse ground glass opacification of lung bases. The patient was admitted to the hospital, and treated with azithromycin and ceftriaxone. However, broad infectious workup was negative. COVID testing was negative and he did not meet the criteria for MIS-C.

To better assess the entire lung fields, a chest CT scan was performed and is shown below.

Chest CT Scan
Chest CT Scan

Question

What key information is likely to be obtained on detailed social history?

A. He adopted a pet parakeet one month ago
B. He has a longstanding history of vaping THC and tobacco products.
C. He just returned from a vacation exploring caves in Lake of the Ozarks.
D. He has a history of ingesting undercooked pork.

Answer