CASE PRESENTATION: A 35 year old female at 32.6 weeks gestation presented to the Emergency Department with acute onset of severe dyspnea and chest pain. She had been intermittently using ENDS, or vaping, over the preceding month, but she reported heavy vaping in the hours before presenting to the ED. Her partner had been self-mixing the vaping cartridges with glycerin, vegetable oil and strawberry flavoring. The patient was afebrile, but in respiratory distress with a white blood cell count of 19,300/mm3. Computed tomography (CT) angiography of the chest showed upper lobe predominant ground glass opacities and “crazy paving” (Image 1). She developed worsening hypoxemia requiring high-flow nasal cannula. 24 hours into hospitalization, tocometer revealed uterine contractions, betamethasone was administered and the patient delivered vaginally in the intensive care unit. Respiratory distress improved and oxygen was weaned off within 48 hours following delivery. The patient was discharged home on hospital day #5 and the infant was discharged home in stable condition after 3 weeks.