DELAYED PRESENTATION OF CHEMICAL PNEUMONITIS AND RELATED RESEMBLANCE TO COVID-19 ASSOCIATED PNEUMONIA IN CT IMAGING: A CASE REPORT

ABSTRACT

SESSION TITLE Imaging, ECMO, and other Procedures in the ICU Case Posters SESSION TYPE Case Report Posters PRESENTED ON 10/19/2022 1245 pm - 0145 pm INTRODUCTION: Inhalation of various organic and non-organic compounds like toxic fumes, batteries, and dust can result in lung irritation called chemical pneumonitis (1). Chemical Pneumonitis can cause acute complications like secondary pneumonia or long-term complications like bronchiectasis or lung destruction (2). Classical radiograph findings of chemical pneumonitis show pulmonary edema or radiographic opacities (3). This type of injury can initially present as no damage in radiograph scans, and the extent of damage can be difficult to determine initially. Chemical pneumonitis can also be difficult to distinguish from pneumonia caused by bacteria or a virus. CASE PRESENTATION A 40-year-old male presented to the emergency department with an 18% total body surface area burn to his upper extremities from an oil pump battery explosion that released chemicals he likely aspirated. The patient was intubated and transferred to the Burn ICU where a bedside bronchoscopy was performed. It revealed no soot or signs of inhalation injury. On the day of admission, he had a 100% oxygen dependence. A CT scan was done and showed no lung damage. The patient was extubated and moved to a high-flow nasal cannula of 40 liters per minute. A repeat CT scan was performed of his chest on hospital day 4. The results appeared to be multifocal pneumonia eliciting a possible diagnosis of Covid 19 pneumonia. This delayed his excision and grafting by 5 days. Through aggressive respiratory therapy intervention, oxygen dependence was reduced until the patient was on room air. The patient was discharged to inpatient rehab on hospital day 21. DISCUSSION: There are several factors presented in this case that should be kept in mind when treating a patient exposed to compounds that can cause chemical pneumonitis. Chemical pneumonitis likely has no findings on bronchoscopy. Furthermore, previous literature has suggested that CT chest scans of chemical pneumonitis may initially present with no apparent injury. Regardless of these initial findings, it is important that patients receive intense pulmonary hygiene to avoid delays in other interventions. Chemical pneumonitis injuries can be associated with chemical burns, and it is imperative to avoid delays in interventions including excision and skin grafting. Findings from a chemical pneumonitis injury may present on a CT scan later in a patient's course of injury. The findings of the CT scan could resemble multifocal pneumonia. This may complicate treatment plans as SARS-CoV-2 is also known to cause multifocal pneumonia. CONCLUSIONS: This case highlights the complexity that chemical pneumonitis traumatic injury may present, and the various factors providers should keep in mind. In the aftermath of the COVID-19 pandemic, another factor has emerged the resemblance of chemical pneumonitis to SARS-CoV-2 multifocal pneumonia. Reference #1 Andujar, P., & Nemery, B. (2009). Pathologies respiratoires aiguës et subaiguës d'origine toxique [Acute and subacute chemical pneumonitis]. Revue des maladies respiratoires, 26(8), 867–885. https//doi.org/10.1016/s0761-8425(09)73682-4 Reference #2 Neill, S., & Dean, N. (2019). Aspiration pneumonia and pneumonitis a spectrum of infectious/noninfectious diseases affecting the lung. Current opinion in infectious diseases, 32(2), 152–157. https//doi.org/10.1097/QCO.0000000000000524 Reference #3.White, C. S., & Templeton, P. A. (1992). Chemical pneumonitis. Radiologic clinics of North America, 30(6), 1231–1243. DISCLOSURES No relevant relationships by Genesy Aickareth No relevant relationships by Deepak Bharadia No relevant relationships by John Griswold No relevant relationships by Alan Pang No relevant relationships by Jad Zeitouni