Purpose or Case Report: ‘E-cigarettes,’ also known as ‘vapes’, are handheld battery-powered devices which heat and deliver aerosolized liquid (usually containing nicotine) to the respiratory tract via inhalation. E-cigarettes are the most commonly used tobacco product amongst youth in the U.S. today. Over 1 in 4 U.S. teens report vaping in the past 30 days. Pod-based forms, such as JUUL, are especially popular with teens. These and other devices are also popular among adults.
The contents of commercially available solutions, or e-liquids, are poorly regulated. Aerosol generated by the devices may contain varying levels of nicotine, flavorings (which are often toxic), heavy metals, ultrafine particles, volatile organic compounds, and other unknown materials. Moreover, users may add substances of their choice to the liquid, including marijuana or other THC-containing products. Short and long-term health effects associated with vaping are incompletely understood, likely in part due to heterogeneity of products, variable consumption amongst users, and the relatively recent introduction and popularization of these devices.
Awareness of negative health effects associated with vaping is increasing. Exposure to highly addictive nicotine has effects on the developing brain, leading to ADHD-like symptoms and often lifelong addiction. Teen e-cigarette use has been associated with an increased risk of future conventional cigarette smoking. Over 1000 cases of acute vaping-associated lung injury in the U.S. have been reported to the CDC as of October, 1, 2019. There is increased recognition of lung injury with early studies identifying a number of imaging patterns of pulmonary disease in adults, including hypersensitivity pneumonitis, diffuse alveolar hemorrhage, acute eosinophilic pneumonia, organizing pneumonia, lipoid pneumonia, and others.
Radiologists should maintain a high index of suspicion for vaping-associated lung injury in the assessment of patients with respiratory distress and possible exposure. Recognition of imaging features of vaping-associated lung injury is especially important in children and young adults, who may not endorse a history of exposure. Identification of clinical and radiologic features associated with e-cigarette use can drive screening and cessation efforts.
In this presentation, we present cases which highlight radiographic and CT imaging features of acute lung disease associated with e-cigarette use in children and young adults.
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