Vaping-related lung damage has a suggestive pattern on CT scans

Reviewed by Emily Henderson, B.Sc.August 27, 2020

A new study published in the journal shows that vaping lung damage shows a suggestive pattern on CT scans, helping doctors make accurate diagnoses and reduce unnecessary biopsies. Radiology: Cardiothoracic imaging.

Electronic nicotine delivery systems, such as e-cigarettes and vaporizers, heat nicotine, fragrances, and other chemicals to create an aerosol that a user inhales. The use of these devices has grown rapidly over the past decade, especially among young people. Inhaled aerosols, commonly referred to as “juice”, can contain many potentially toxic or harmful substances.

Last year, the Centers for Disease Control and Prevention (CDC) received its first report on a condition known as lung injury (EVALI) associated with the use of electronic cigarettes or products. Three criteria that define EVALI: Exclusion of e-cigarette use or vaping within 90 days of onset of symptoms, abnormal chest images, and other potential sources of damage such as infections. Within 6 months of the first case, approximately 3,000 hospitalized EVALI cases were reported to the CDC, confirming 68 deaths.

Last year, a pathologist at the Mayo Clinic in Scottsdale, Arizona, published a paper explaining the unique pattern of lung injury in adolescents using Arc Plasma products. The injured wrapped around the bronchus, a bronchus that branches from the trachea to the lungs.

Mayo Clinic radiologist Michael B. Gotway, MD, recently expanded its study by looking for patterns in chest CT scans that may correlate with previously observed pathological findings. The study included 26 patients who met the EVALI criteria and underwent CT and biopsy or other type of tissue removal. Dr. Gottway classified CT scan patterns according to several different recognized patterns. One pattern is frosted glass opacity. CT scans appear whiter than normal, but they do not obscure the underlying structures of the lungs. The other is CT integration or white area congestion.

We read a CT scan, plugged it into one of those patterns and associated it with histopathology. What we have found is that frosted glass opacity is the most common pattern found in EVALI, with occasional toughening. “

Michael B. Gottway MD, Mayo Clinic Radiologist

That pattern was more common than the CT pattern, which resembles subacute hypersensitivity pneumonia, a term for inflammation of lung tissue.

The findings of this study and other related studies may provide important diagnostic tools for physicians treating young patients with symptoms such as chest pain and shortness of breath.

“If a radiologist has diffuse lung opacities in a young patient whose cause is uncertain, he may want to inform the radiologist that he may want to seriously consider the patient’s potential for vascular injury. I think,” Dr. Gotway said. “Patients may not immediately recognize that they are using the material, but radiologists recognize these patterns, which could tell the clinician that it was the damage caused by vaping. You can test for nicotine metabolites or ask patients about this if they tell you that there is an exposure.”

Such an approach would help reduce lung biopsy with considerable expense, risk of complications, and additional patient anxiety.

“These radiological findings are of particular benefit to doctors as they help them determine potentially less invasive treatment options,” Dr. Gottway said. “We could work with our clinical colleagues to make the diagnosis non-invasively. By alerting us to scan patterns suggesting a possible EVALI, we avoid the need to see a surgeon. Become.”

Researchers have found some good news in their work. It seems that the signs of EVALI on the image resolve immediately when the use of problematic drugs, often supplemented with corticosteroid therapy, is stopped.