E2128. Deeper Dive into Patient’s History: Drug-Induced and Toxic-Metabolic Diagnoses in a Metropolitan Emergency Room
  1. Kevin Yan; NYU Langone Medical Center
  2. Rajiv Shah; NYU Langone Medical Center
As the prevalence of illegal recreational drugs increases in the overall population and the introduction of new drugs into society, the prevalence of toxic and metabolic disease processes is also increased. In addition, additional metabolic and toxic abnormalities such as from chronic alcoholism, diabetes, or e-cigarette use also frequently present to the emergency department with nonspecific chief complaints. It can be very difficult to differentiate toxic and metabolic pathologies from other more prevalent disease processes in the world due to very similar imaging characteristics on different modalities. However, in these cases, eliciting a proper history and doing a thorough chart review can lead to a more accurate diagnosis, which in turn will lead to rapid initiation of proper time-sensitive treatment in these critical patients. This educational exhibit aims to review the common imaging findings and pathologies for toxic and metabolic diseases that radiologists can encounter in an emergency department.

Educational Goals / Teaching Points
The goals of this exhibit are multimodality imaging review of drug induced and toxic-metabolic conditions including ultrasound, CT, and MRI, with classic imaging characteristics of the various pathologies. There will also be a multidisciplinary review of the epidemiology, diagnosis, differential diagnosis, management, and further imaging recommendations of these cases.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
A case-based review will be provided for the following cases: cocaine-induced hepatic hematoma, ketamine cystitis, ketamine cholangiopathy, vaping-associated lung disease, heroin leukoencephalopathy, hypoglycemic encephalopathy, and central pontine osmotic demyelination.

With the prevalence of drug-induced and toxic-metabolic diseases at high levels, it is important for radiologists to be familiar with imaging characteristics and diagnosis of these pathologies as the clinical management of these conditions is drastically different than the other pathologies in the differential diagnosis. Many of these conditions require time-sensitive management and treatment, so timely diagnosis is essential for the prognosis of the patient.