E-Cigs, Vaping Linked to Nonspecific Imaging Findings

By Will Boggs MD

November 09, 2019

NEW YORK (Reuters Health) - Using electronic cigarettes or vaping is associated with lung injury that can appear as nonspecific findings on chest radiography and CT, researchers report.

"There is no one radiological finding that can reliably diagnose electronic-cigarette- or vaping-associated lung injury (EVALI)," said Dr. Suhny Abbara of UT Southwestern Medical Center, in Dallas, Texas.

"The findings we see are not specific to this new disease. The diagnosis needs to be established by excluding other diseases that may have the same imaging findings, such as acute lung infection," he told Reuters Health by email.

Previous studies have noted ground-glass opacities with subpleural sparing and basilar predominance in most patients with EVALI who undergo chest CT.

Dr. Abbara and Dr. Fernando Uliana Kay describe radiographic and CT findings of lung injury in a 24-year-old male patient with past medical history of asthma who presented with shortness of breath, productive cough, chest pain and fever for one week. The patient reported everyday use of e-cigarettes (with tobacco) and marijuana.

Posteroanterior chest radiograph showed bilateral reticular and predominantly ground-glass and airspace opacities distributed throughout both lower lungs. Chest CT the following day identified patchy ground-glass opacities distributed bilaterally with some subpleural sparing and consolidation in the lung bases.

Histologic specimens obtained at transbronchial biopsy stained positive for lipid, suggesting lipoid pneumonia, the authors report in Radiology: Cardiothoracic Imaging, online October 31.

These findings are consistent with recent findings, reported by Reuters Health, of disrupted lipid homeostasis in the lungs of mice exposed to e-cigarette solvents.

The patient was treated with steroids for presumptive lung injury associated with e-cigarette use.

"Consider EVALI in your differential diagnostic list in acutely ill patients with bilateral lung opacities," Dr. Abbara said. "This includes teenage patients. Parents may not necessarily be aware of a vaping history of their children, and some teenagers may be hesitant to admit to vaping product use in front of their parents when first asked by a health care provider."

"We need to understand this disease better so that we may better prevent, diagnose, and treat EVALI," he said.

SOURCE: https://bit.ly/2Nrcdhh

Radiol Cardiothorac Imaging 2019.