Purpose or Case Report: E-cigarette/vaping-associated lung injury (EVALI) has been recently reported in the radiology literature and has become an urgent public health matter as stated by the Center for Disease Control and Prevention. As of October 22, 2019, there have been 1,604 cases in the United States territory with 34 confirmed deaths. Patients <20 years represent 36% of EVALI cases. Moreover, the use of vaping among adolescents and teenagers has progressively increased in recent years. Although the exact cause and mechanism of injury remain a subject of investigation, clinical suspicion along with imaging findings and in some cases, bronchoscopic results, remain the mainstay in the diagnosis of EVALI, after excluding infection. Reported imaging patterns of EVALI include hypersensitivity pneumonitis, diffuse alveolar hemorrhage, acute eosinophilic pneumonia, diffuse alveolar damage, lipoid pneumonia, and giant cell interstitial pneumonia. We describe computed tomography (CT) findings of EVALI patients from our institution
Methods & Materials: This is a HIPAA-compliant retrospective study of symptomatic patients with history of vaping that were evaluated by Pulmonology from December 2018 to October 2019. Demographic and clinical data that included vaping use, symptoms, laboratory results, imaging and bronchoscopy findings, and treatment were documented
Results: We found 12 cases, 6 females and 6 males, with age range 13-18 years (mean 15.9). Ten patients had vaped for at least 2 months while two had for “several weeks”. All, except one that only used nicotine, reported the use of tetrahydrocannabinol (THC). All patients had respiratory symptoms, ten had gastrointestinal symptoms and eight had fever. Eight cases had elevated inflammatory markers. On CT, all cases showed a continuum of ground-glass opacities. Interlobular septal thickening (7), subpleural sparing (5), nodules (3), crazy-paving (1), pneumomediastinum (1) and bilateral pleural effusions (1) were also found. Of a total of five bronchoalveolar lavages (BALs), few lipid-laden macrophages (instead of >25%, as recently reported), eosinophilia or neutrophilia, were each found in two. Notably, one patient required ECMO for 1.5 months
Conclusions: Radiologists should be knowledgeable of the spectrum of CT imaging manifestations of EVALI because we may be the first to raise the specific concern for this entity and prompt vaping cessation, especially, in the presence of respiratory and gastrointestinal symptoms along with fever and elevated inflammatory markers