Artunduaga Maddy,  Rao Devika,  Friedman Jonathan,  Kwon Jeannie,  Pfeifer Cory

Final Pr. ID: Paper #: 003 (S)

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 Read More

Authors:  Artunduaga Maddy , Rao Devika , Friedman Jonathan , Kwon Jeannie , Pfeifer Cory

Keywords:  Vaping, Vaping-associated lung injury, E-cigarette-associated lung injury

Thakrar Pooja,  Boyd Kevin,  Wideburg Eric,  Kumbhar Sachin

Final Pr. ID: Poster #: EDU-072

The incidence of e-cigarette, or vaping, product use associated lung injury (EVALI) has been increasing since the summer of 2019. At least seven distinct patterns of lung injury have been described with this emerging disease (1). A recent report from the United States Centers for Disease Control and Prevention indicates that approximately 15% of patients diagnosed with EVALI have been in the pediatric age group (2). Because of the potential legal and social repercussions of vaping and cannabis use, pediatric patients may be disinclined to admit to use of electronic cigarettes. As such, recognition of the potential imaging patterns of this disease may allow the pediatric radiologist to raise the possibility of EVALI to facilitate timely diagnosis and appropriate management of the disease.

This educational exhibit will review the imaging findings seen in the various patterns of lung injury identified with this increasingly common lung disease. We will also discuss the indications for obtaining imaging studies in patients with suspected EVALI. In addition, we will describe the potential clinical presentations in these patients.

References:
1. Henry TS, Kligerman SJ, Raptis CA, et al. (2019) Imaging findings of vaping-associated lung injury. AJR 1-8. 10.2214/AJR.19.22251
2. Centers for Disease Control and Prevention. (2019) Severe pulmonary disease associated with electronic cigarette product use—interim guidance. https://www.cdc.gov/mmwr/volumes/68/wr/mm6836e2.htm Read More

Authors:  Thakrar Pooja , Boyd Kevin , Wideburg Eric , Kumbhar Sachin

Keywords:  EVALI, vaping-associated lung injury, adolescent

Hook Marcus,  Barrera Ambika,  Biko David,  Dennis Rebecca,  Rapp Jordan

Final Pr. ID: Paper #: 029

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. Read More

Authors:  Hook Marcus , Barrera Ambika , Biko David , Dennis Rebecca , Rapp Jordan

Keywords:  Vaping, Lung injury, Pneumonia

Wang Kevin,  Lee Stanley,  Yenduri Naga Jaya,  Farber Harold,  Guillerman R

Final Pr. ID: Paper #: 033

Electronic cigarette (e-cigarette) or vaping product associated lung injury (EVALI) has become epidemic across the United States. To assist in prompt diagnosis, we describe the imaging features of adolescent EVALI. Read More

Authors:  Wang Kevin , Lee Stanley , Yenduri Naga Jaya , Farber Harold , Guillerman R

Keywords:  Vaping, E-cigarette

Dunn Emily,  Bokhari Danial,  Machnitz Judit,  Facciola James,  Lu Monica,  Aoyama Brianna,  Sadreameli S. Christy,  Tekes-brady Aylin

Final Pr. ID: Poster #: EDU-073

‘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. Read More

Authors:  Dunn Emily , Bokhari Danial , Machnitz Judit , Facciola James , Lu Monica , Aoyama Brianna , Sadreameli S. Christy , Tekes-brady Aylin

Keywords:  e-cigarette, vaping, lung injury

Krishnan Vijay,  Schenker Kathleen,  Saul David

Final Pr. ID: Poster #: EDU-074

Vaping is a recreational activity of inhaling heated liquid vapor from electronic cigarettes which has been increasingly used as an alternative to cigarettes. Common substances that may be used in the liquids include nicotine, tetrahydrocannabinol, cannabinoid oils and other additives. There is increasing concern about lung injury associated with vaping, especially in children. While a nascent body of literature is beginning to develop regarding this entity, further investigation from different geographic regions (with access to varying chemical profiles of vaping material) and in differing age populations is necessary to ascertain the imaging patterns of vaping associated lung injury. In this poster, we describe the imaging patterns of pediatric vaping associated lung injury we encountered in our institution. Although this is inherently a diagnosis of exclusion, we consider these imaging patterns strongly suggestive if there is a history of vaping and absence of other risk factors or preexisting disease. We observed the following imaging patterns of lung injury associated with vaping:

Chest radiograph findings:
1) Normal.
2) Coarse bilateral interstitial opacities.
3) Pseudo pulmonary edema pattern: bilateral central predominant air space opacities with peripheral sparing.
4) Mixed pattern: combination of air space opacities and reticular opacities.

Various patterns of computed tomography findings:
1) Bilateral central ground glass opacities (GGO).
2) Sub pleural sparing , in most of the cases.
3) Interlobular septal thickening in association with GGO - crazy paving pattern.
4) Lower lobe predominant thick subpleural parenchymal bands.
5) Scattered GGO without any lobar predominance - an atypical finding seen in one patient.
6) Mild bronchial wall thickening

Take home message:
- Bilateral central predominant ground glass opacities with lower lobe predominance and sub pleural sparing are the most consistent findings seen in most of the cases. The GGO show an anteroposterior (dependent) gradient of increasing attenuation.
- Posterior dependent parenchymal bands were observed subjacent to subpleural spared lung parenchyma in several cases, a finding which has not been described previously to our knowledge. These parenchymal bands, in association with above mentioned findings, are highly suggestive of vaping associated lung injury in the appropriate clinical setting.
- We have observed complete resolution of findings in at least two of the cases on short term followup. Read More

Authors:  Krishnan Vijay , Schenker Kathleen , Saul David

Keywords:  vaping, electronic cigarette

Poyiadji Neo,  Sabharwal Gauravi,  Leschied Jessica,  Ledbetter Karyn,  Song Tom,  Collins Denise,  Montecalvo Joseph

Final Pr. ID: Poster #: CR-034

E-cigarette, or vaping, product use associated lung injury (EVALI) is a newly recognized entity that is being reported with increasing frequency in the literature and mainstream press. The aim of this case report is to radiographically illustrate the fairly rapid progression of a severe case of EVALI that ultimately required a successful bilateral lung transplant, and to describe a unique histopathology correlation.

Case Report:
Our patient is a 16-year-old, previously healthy male with a two year history of vaping who presented to an outside hospital for dyspnea and nonproductive cough. He was initially treated with antibiotics for community acquired pneumonia. Initial contrast-enhanced CT of the chest demonstrated subtle bilateral but right lower lobe predominant centrilobular nodules, ground glass opacities (GGO) and mild septal thickening. Bronchial alveolar lavage, microbiology studies and autoimmune panel were negative for an infectious or autoimmune etiology. Repeat chest CT only five days later following clinical deterioration demonstrated a dramatic worsening of bilateral nodular airspace opacities, septal thickening, GGO and dependent diffuse consolidations. Pneumomediastinum and mild bronchiectasis were also present. Our patient’s condition continued to decline requiring intubation and subsequent ECMO support. He was transferred to our tertiary care center for bilateral lung transplant. Histopathology of the explanted lungs described predominant acute necrotizing and granulomatous bronchopneumonia with areas of organizing pneumonia. Read More

Authors:  Poyiadji Neo , Sabharwal Gauravi , Leschied Jessica , Ledbetter Karyn , Song Tom , Collins Denise , Montecalvo Joseph

Keywords:  Vaping related lung injury, lung transplant