E-cigarette, or vaping, product use-associated lung injury in adolescents: a review of imaging features

• Published in: Pediatric radiology 2020-03, Vol.50 (3), p.338-344
• Main Authors: Thakrar, Pooja D., Boyd, Kevin P., Swanson, Craig P., Wideburg, Eric, Kumbhar, Sachin S.
• Format: Article
• Language: English
• Subjects: Acute Lung Injury - diagnostic imaging; Acute Lung Injury - physiopathology; Adolescent; Adolescents; Alveoli; Bronchus; Cannabis; Chest; Cigarettes; Computed tomography; Dyspnea; Effusion; Electronic cigarettes; Electronic Nicotine Delivery Systems - statistics & numerical data; Etiology; Female; Glass; Humans; Identification methods; Illnesses; Imaging; Inflammation; Inhalation; Injuries; Laboratories; Lipids; Lung - diagnostic imaging; Lung - physiopathology; Lung diseases; Lymph nodes; Macrophages; Male; Medical imaging; Medicine; Medicine & Public Health; Neuroradiology; Nicotine; Nodules; Nuclear Medicine; Oncology; Original Article; Patients; Pediatrics; Pulmonary functions; Radiographs; Radiography; Radiography - methods; Radiology; Respiration; Respiratory diseases; Respiratory function; Respiratory Function Tests - statistics & numerical data; Retrospective Studies; Signs and symptoms; Teenagers; Thickening; Tomography, X-Ray Computed - methods; Ultrasound; Vaping; Vaping - adverse effects
• ISSN: 0301-0449; 1432-1998
• DOI: 10.1007/s00247-019-04572-5

Background There has been a recent increase in recognition of lung disease related to the use of electronic cigarettes (called “vaping”). These patients present with acute respiratory illness following exposure to vaporized cannabis or nicotine products and sometimes require hospitalization and intensive care. We describe the imaging findings of this disease entity in the pediatric population. Objective To describe the radiologic findings of lung injury associated with electronic cigarette use (vaping) in the adolescent pediatric population. Materials and methods We identified all adolescents with acute respiratory illness and a history of electronic cigarette use who presented at our institution within a 3-month period (June 2019 through August 2019). We excluded adolescents with potential intercurrent pulmonary disease. We reviewed the charts for symptomatology and laboratory and pathology data. In addition, we reviewed the chest radiographs and chest CTs of these adolescents. Results The review group consisted of 12 teenage pediatric patients (10 boys and 2 girls; mean age 16.9 years, range 16.0–17.7 years) with acute respiratory illness found to have a temporal association with electronic cigarette use for cannabis products, nicotine, or both. Other etiologies for illness in these adolescents had been excluded by clinical and laboratory evaluation. All of the adolescents were admitted to the hospital for treatment. The clinical presentations included dyspnea, abdominal pain and constitutional symptoms. Pulmonary function testing that was performed in all patients during admission or follow-up demonstrated reduced diffusion capacity in 4/12 (33%), an obstructive ventilatory pattern in 4/12 (33%), a restrictive pattern in 1/12 (8%), and a mixed obstructive and restrictive pattern in 2/12 (17%) adolescents. Bronchoalveolar lavage studies, performed in 9 of the 12 adolescents, revealed inflammatory cells and lipid-laden macrophages. All of the patients underwent CT of the chest; the findings were notable for centrilobular ground-glass nodules (11/12; 92%) and confluent ground-glass opacities (12/12; 100%), with frequent subpleural sparing (9/12; 75%). Additionally, 6/12 (50%) adolescents demonstrated small pleural effusions; 6/12 (50%) had mild bronchial wall thickening; 9/12 (75%) had enlarged hilar or mediastinal lymph nodes; and 2/12 (17%) had a small pericardial effusion. Conclusion As seen in our teenage population, e-cigarette, or vaping, product use