Radiological Case: Electronic-Cigarette or Vaping Associated Lung Injury (EVALI)

William H Kinney, DO, PGY-1; Collin Beckstrom, OMS IV; Travis Snyder, DO; Paul Judiscak, DO, PGY-3; Phil Miller, DO, PGY-2; John Marett, MD, PGY-1; Annelisa Pessetto, OMS IV; Dmitry Scherbak, DO


Appl Radiol. 2020;49(2):42-44. 

In This Article

Case Summary

A 37-year-old presented to the hospital with 3 days' duration of increasing shortness of breath, subjective fevers, headache, dry cough, pleuritic chest pain, chest tightness, nausea, and vomiting. The patient denied any sick contacts and reported quitting cigarette smoking 4 years previously with an approximately 20-year-pack history. The patient reported currently vaping nicotine daily, along with occasional cocaine and marijuana use, reportedly last using intranasal cocaine 2 nights prior to presentation. The patient reported using a vaping device with nicotine juice, had last changed the heating coil about 1 week prior to presentation, and reported vaping about 3 pods a day. The patient was dyspneic, agitated, and had mild diffuse crackles on lung exam. Oxygen saturation was 79% on room air; Respiratory Virus Panel PCR, 4th generation HIV testing, Histoplasma antigen, and urinary antigens for streptococcus and legionella were all negative. Bronchoalveolar lavage was unremarkable. Bronchial biopsy was notable for fibrin exudates within airspaces, with occasional lipid-laden macrophages highlighted by Oil Red O stain. Laboratory values were notable for elevated d-dimer, procalcitonin, C-reactive protein, and leukocytes. A urine drug screen was positive for cannabis and cocaine.