Presentation
Shortness of breath, desaturation. No fever.
Patient Data
Perihilar linear opacities.
Micronodules scattered throughout lungs, with bibasal preponderance.
Subsegmental atelectasis in lung bases.
No embolus in main pulmonary arteries or segmental branches.
Non-enlarged bihilar lymph nodes, probably reactive.
Innumerable diffusely scattered tree-in-bud infiltrates in all lung lobes.
Subsegmental atelectasis in lung bases.
Case Discussion
Shortness of breath and desaturation as low as 89% in room air. Treated with methylprednisolone and inhalations. Echocardiogram normal.
Chest x-rays showed pulmonary micronodules. Pulmonary function tests showed a severe irreversible obstructive lung disease (decrease in FEV1 to 30%) with a disturbance in diffusion.
Urine toxicology came back positive for cocaine and marijuana.
A CTPA done 5 days later showed extensive, diffuse tree-in-bud infiltrates. The pediatric toxicologist was of the opinion that the clinical and radiological picture most probably represented pneumonitis caused by a direct insult to the lungs from cocaine inhalation ("snorting").
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