Electronic Cigarette or Vaping Product Use–associated Lung Injury: Diffuse Alveolar Damage

CT images in a 35-year-old man with history of vaping tetrahydrocannabinol. A, Initial chest CT image shows diffuse ground-glass attenuation with subpleural sparing (white arrows), sparing of the peribronchovascular interstitium (black arrows), and interlobular septal thickening with a crazy-paving pattern. The patient’s condition deteriorated, and, B, subsequent chest CT image 15 days later shows increased fibrosis, including reticulation and traction bronchiectasis (black arrows) and right-greater-than-left pneumothoraces extending into the fissures, likely due to alveolar rupture from noncompliant lungs. These are typical findings of diffuse alveolar damage. Note the placement of bilateral chest tubes.

A 35-year-old man presented with dyspnea and history of vaping tobacco products for 4 years and recent switch to vaping tetrahydrocannabinol (THC) 2 months prior to admission. Initial chest CT results showed diffuse groundglass attenuation with subpleural sparing, sparing of the peribronchovascular interstitium, and interlobular septal thickening with a crazy-paving pattern. The patient was initially treated with antibiotics and steroids. However, the patient’s condition deteriorated with symptoms consistent with acute respiratory distress syndrome requiring mechanical ventilation. Subsequent chest CT results showed increased fibrosis, including reticulation and traction bronchiectasis, and right-greater-than-left pneumothoraces extending into the fissures, likely due to alveolar rupture from noncompliant lungs. These findings are typical of diffuse alveolar damage. Patient underwent right-sided mechanical pleurodesis and eventually recovered.

Electronic cigarette or vaping product use–associated lung injury (EVALI) is an emerging complication of vaping (especially with use of THC-based products). It is characterized by acute lung injury manifested as organizing pneumonia and/or diffuse alveolar damage, as shown in this case. Although imaging findings of EVALI are nonspecific, radiologists should recognize the imaging pattern and raise the concern for this diagnosis in the correct clinical setting, prompting timely and appropriate treatment.