Purpose or Case Report: Vaping associated pulmonary injury (VAPI) has recently received national attention as an epidemic resulting in cases of significant morbidity and mortality from electronic cigarette use. The purpose is to present the clinical and imaging findings in adolescents with pulmonary symptoms from suspected VAPI.
Methods & Materials: Imaging of all adolescents (<19 years old) with acute pulmonary symptoms and history of vaping were assessed. Imaging findings on chest radiographs and CT scans were reviewed by two radiologists in consensus. Clinical presentation and laboratory data was derived from the electronic medical records including pulmonary function tests (PFTs), bronchoscopy, and pathology if available.
Results: A total of 10 patients were identified (8 male, mean age 16.6 years, 15 to 18 years). Most common presentation was progressive, subacute respiratory distress with accompanying abdominal pain. All but one of the patients tested positive for THC on urine drug screen. Most (70%) had an elevated white blood cell count and serum inflammatory markers. Chest radiograph features were most notable for interstitial pattern of opacities (100%) and basilar predominance of abnormalities (80%). CT features were most notable for extensive ground glass opacities (89%), interstitial opacities (78%), subpleural sparing (67%) and apical to basilar gradient (78%). No cases demonstrated imaging evidence of lipoid pneumonia. One patient negative for THC had inconsistent imaging findings demonstrating multifocal peripheral nodular opacities, large basilar consolidations, and small bilateral pleural effusions. Seven patients underwent PFTs which most frequently demonstrated mildly impaired diffusion (43%). One patient underwent flexible bronchoscopy and bronchoalveolar lavage with pathology demonstrating neutrophilia and lipid droplets in macrophages. Average length of hospital stay was 6 days. All patients received supportive treatment with supplemental oxygen and corticosteroids. Four required ICU admission.
Conclusions: Adolescents with suspected VAPI most commonly present with subacute respiratory distress with abdominal pain. Imaging findings of ground glass opacities, subpleural sparing, and an apical to basilar gradient were seen most consistent with organizing pneumonia or hypersensitivity pneumonitis. Recognition of the common spectrum of imaging findings may have significant patient management implications, especially if the diagnosis is not suspected clinically.