Clinical and radiological characteristics of e-cigarette or vaping product use associated lung injury

Abstract

Purpose: E-cigarette or vaping product use associated lung injury (EVALI) has received national attention as an epidemic resulting in cases of significant morbidity and mortality. We aim to present the clinical and imaging findings in adolescents with pulmonary symptoms from suspected EVALI.

Methods: Chest radiographs and CTs of adolescents (< 19 years) with acute pulmonary symptoms and history of vaping were reviewed by two radiologists in consensus. Clinical presentation and laboratory data were derived from the electronic medical records including pulmonary function tests (PFTs).

Results: Eleven patients were identified (9 male, mean 16.6 years). The most common presentation was progressive, subacute respiratory distress with abdominal pain. All but one of the patients tested positive for tetrahydrocannabinol. Chest radiograph features were notable for interstitial pattern of opacities (91%) and basilar abnormalities (82%). CT features were notable for ground-glass opacities (89%), interstitial opacities (78%), and subpleural sparing (67%). Eight patients underwent PFTs. Six had diffusing capacity measurement, which demonstrated impaired diffusion in 3 (50%). All patients received supportive treatment with supplemental oxygen and corticosteroids.

Conclusion: Adolescents with suspected EVALI commonly present with subacute respiratory distress with abdominal pain. Imaging findings include ground-glass opacities, subpleural sparing, and basilar opacities, most consistent with organizing pneumonia or hypersensitivity pneumonitis. Recognition of the common imaging findings may have significant patient management implications, especially if the diagnosis is not suspected clinically. The lung function effects of vaping are consistent with mildly reduced airflow, which improves on follow-up testing, and reduced diffusion capacity, which, concerningly, does not improve.

Keywords: Adolescents; Chest; EVALI; PFTs.

Fig. 1

a A 16 year-old male (patient 6) presents with cough, fever, and emesis. Chest radiograph on day of presentation demonstrates bilateral symmetric interstitial opacities in a basilar predominance distribution. b Coronal non-contrast CT chest in lung windows from the same day demonstrated bilateral, symmetric ground-glass (circle) and interstitial opacities (arrowhead) in an apical to basilar distribution with subpleural sparing (black arrows). Bronchial wall thickening is also seen (white arrow)

Fig. 2

A17-year-old male (patient 3) with past medical history of asthma presented to the emergency department with increased work of breathing and hypoxia. Axial contrast-enhanced CT chest in lung windows demonstrates asymmetric bilateral ground-glass opacities with subpleural sparing (arrows) and reverse halo signs (arrowheads)

Fig. 3

A 17-year-old male (patient 11) with past medical history of asthma presented to the emergency department with respiratory failure, fever, and vomiting. Axial contrast-enhanced CT chest in lung windows demonstrates similar findings as in Fig. 2 with bilateral symmetric ground-glass opacities with subpleural sparing (arrows) and reverse halo signs seen bilaterally (arrow heads). Pneumomediastinum is also present (asterisk)