General Pulmonology

Considering EVALI in CT Findings of Acute Lung Injury

Avatar photoVirginia A. Schad, PharmD, RPh
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This frontal view x-ray of the chest shows advanced stage non-small cell lung cancer (NSCLC) of a 50-year-old woman with a long history of smoking and emphysema. The orange area depicts collapsed lung tissue at the base of the right lung, and the yellow area highlights a pleura-based density along the right hemithorax.
This frontal view x-ray of the chest shows advanced stage non-small cell lung cancer (NSCLC) of a 50-year-old woman with a long history of smoking and emphysema. The orange area depicts collapsed lung tissue at the base of the right lung, and the yellow area highlights a pleura-based density along the right hemithorax.
Vaping exposure should be included in the clinical history of all patients with CT findings of acute lung injury without another known cause, particularly if they are young and otherwise healthy.

Vaping exposure should be included in the clinical history of all patients with computed tomography (CT) findings of acute lung injury without another known cause, particularly if they are young and otherwise healthy, according to the results of a multicenter, retrospective study published in CHEST.

Electronic cigarette and vaping-induced lung injury (EVALI) causes a spectrum of CT lung injury patterns; however, relative frequencies and associations with vaping behavior are unknown. Therefore, researchers sought to determine the frequencies of imaging findings and CT patterns in EVALI and their relationship to vaping behavior in 160 individuals.

A total of 77 (48.1%), 15 (9.4%), and 68 (42.5%) patients admitted to vaping marijuana derives (tetrahydrocannabinol [THC]), nicotine, or both, respectively. Common findings included diffuse or lower lobe ground glass opacity (GGO) with subpleural (78.1%), lobular (59.4%), or peribronchovascular (PBV) sparing (40%). Septal thickening (50.6%), lymphadenopathy (63.1%), and centrilobular nodules (CN) (36.3%) were common. PBV sparing was associated with younger age (P =.02), and 156 (97.5%) patients had 1 of 6 defined patterns.

Parenchymal, airway-centered, and mixed organizing pneumonia (OP) patterns were seen in 89 (55.6%), 14 (8.8%), and 32 (20%) patients, respectively. Acute eosinophilic pneumonia (AEP)-like (6/160; 3.8%), diffuse alveolar damage (DAD) (9/160; 5.6%), pulmonary hemorrhage (DAH) (6/160; 3.8%), and atypical (4/160; 2.5%) patterns were less common. Increased vaping frequency was associated with more severe injury (P =.008). A multivariable analysis showed a negative association between vaping for more than 6 months and DAD pattern (P =.03).

A total of 2 patients (1.25%) with DAD pattern died. There was no relation between pattern and injury severity, geographic location, and state legality of recreational use of THC.

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“Although most cases of EVALI were thought to be related to THC-containing compounds, we found no difference in vaping substances and behaviors and CT pattern of lung injury,” concluded the study authors. “Furthermore, 15% of our cases occurred after the onset of the COVID-19 pandemic, highlighting the importance of recognizing the overlap of CT appearances of EVALI with COVID-19.”

Reference

Kligerman SJ, Kay FU, Raptis CA, et al. CT findings and patterns of Electronic Cigarette or Vaping Product Use-Associated Lung Injury (EVALI), a multicenter cohort of 160 cases. CHEST. Published online May 3, 2021. doi:10.1016/j.chest.2021.04.054

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