CT Findings and Patterns of Electronic Cigarette or Vaping Product Use-Associated Lung Injury (EVALI), A Multicenter Cohort of 160 Cases.

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Electronic cigarette and vaping-induced lung injury (EVALI) causes a spectrum of CT lung injury patterns. Relative frequencies and associations with vaping behavior are unknown.What are the frequencies of imaging findings and CT patterns in EVALI and what is the relationship to vaping behavior?CT scans of 160 subjects with EVALI from 15 institutions were retrospectively reviewed. CT findings and patterns were defined and agreed upon via consensus. The parenchymal organizing pneumonia (OP) pattern was defined as regional or diffuse GGO +/- consolidation without centrilobular nodules (CN). An airway-centered OP pattern was defined as diffuse CN with little or no GGO while a mixed OP was a combination of the two. Other patterns included diffuse alveolar damage (DAD), acute eosinophilic pneumonia-like (AEP-like), and pulmonary hemorrhage (DAH). Cases were classified as atypical if they did not fit into a pattern. Imaging findings, pattern frequencies and injury severity were correlated with substance vaped (marijuana derives [THC] only, nicotine derivates only, and both), vaping frequency, regional geography, and state recreational THC legality. One-way ANOVA, Chi square test, and multivariable analyses (MVA) were used for statistical analysis.160 patients (79.4% male) with mean age of 28.2 years (range 15-68) with EVALI underwent CT. Seventy-seven (48.1%), 15 (9.4%), and 68 (42.5%) admitted to vaping THC, nicotine, or both, respectively. Common findings include diffuse or lower lobe GGO with subpleural (78.1%), lobular (59.4%) or peribronchovascular (PBV) sparing (40%). Septal thickening (50.6%), lymphadenopathy (63.1%), and CN (36.3%) were common. PBV sparing was associated with younger age (p=0.02). 156 of 160 (97.5%) subjects had 1of 6 defined patterns. Parenchymal, airway-centered, and mixed OP patterns were seen in 89 (55.6%), 14 (8.8%), and 32 (20%) respectively. AEP-like (6/160, 3.8%), DAD (9/160, 5.6%), 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=0.008). Multivariable analysis showed a negative association between vaping for >6 months and DAD pattern (p=0.03). Two subjects (1.25%) with DAD pattern died. There was no relation between pattern and injury severity, geographic location, state legality of recreational use of THC.EVALI typically causes an OP pattern but exists on a spectrum of acute lung injury (ALI). Vaping habits do not correlate with CT patterns except for negative correlation between vaping >6 months and DAD pattern. PBV sparing, not previously described in ALI, is a common finding.

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Authors: Seth J Kligerman, Fernando U Kay, Costantine A Raptis, Travis S Henry, Jacob W Sechrist, Christopher M Walker, Daniel B Vargas, Peter D Filev, Michael S Chung, Subba R Digumarthy, Alan M Ropp, Tan-Lucien Mohammed, Kristen W Pope, Kaitlin M Marquis, Jonathan H Chung, Jeffrey P Kanne


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