Imaging Study Reveals What Vaping Lung Injury Looks Like in Teens

By Reuters Staff

March 05, 2020

NEW YORK (Reuters Health) - Vaping-associated lung injury in teenagers is characterized by bilateral symmetric ground-glass opacities with subpleural sparing, consolidation and a lower-lobe predominance, according to the first study to examine both chest x-ray and CT imaging findings in this patient population.

E-cigarettes, also known as vapes, are battery-powered devices that allow uses to inhale flavors, tetrahydrocannabinol, and/or nicotine. First introduced in the United States around 2007, they are growing in popularity among young people.

Starting in 2012, several case reports emerged raising the possibility of a link between e-cigarette use and severe lung injury. According to federal health officials, as of January 14, 2020, there have been 2,668 reported cases with 60 confirmed deaths due to e-cigarette or vaping product use-associated lung injury (EVALI) in the U.S., with patients younger than 18 years making up 15% of reported hospitalizations due to EVALI.

To get a better understanding of what's happening in the lungs of teenagers with EVALI, a team led by Dr. Maddy Artunduaga of UT Southwestern Medical Center in Dallas, Texas, reviewed chest x-ray and CT findings performed within four days of presentation in seven boys and seven girls between 13 and 18 years old with EVALI.

Chest x-ray findings included ground-glass opacity in all 14 patients (100%) and consolidation in eight (57%). CT findings included ground-glass opacity in all patients, consolidation in nine (64%), and interlobular septal thickening in two (14%). CT also revealed subpleural sparing in 11 patients (79%) and a reversed halo sign in five (36%).

Chest x-ray and CT abnormalities were bilateral in all 14 patients (100%) and symmetric in 13 (93%), with lower-lobe predominance in seven (50%). The extent of abnormality was predominantly diffuse at both chest x-ray and CT.

"There was almost perfect interobserver agreement between two reviewers for detecting abnormalities on chest radiographs (k = 0.99; 95% confidence interval: 0.97, 1.00) and CT (k = 0.99; 95% confidence interval: 0.98, 1.00)," the researchers report in Radiology.

In a statement, Dr. Artunduaga noted that chest x-ray alone is not sufficient to characterize patterns of EVALI in pediatric patients and, therefore, CT is needed for a complete assessment.

"CT provides a better evaluation of the extent and degree of involvement, as well as a better assessment of the characteristics of abnormal pulmonary findings. This can lead to the early diagnosis of EVALI, which would ultimately allow the timely management of this entity in the pediatric population," she said.

"Radiologists will continue to play an important role in the initial detection and follow-up of pediatric patients with EVALI. When these imaging findings are observed in pediatric patients, with or without the history of exposure to e-cigarette or vaping products, EVALI should be included as a diagnostic possibility," she said in the statement.

SOURCE: Radiology, online March 3, 2020.