Abnormal findings affirm radiologists' key role in EVALI fight

A new review published Jan. 28 in Radiology asserts that imaging experts must play a central role in understanding and diagnosing vaping product use-associated lung injury.

Public health officials continue to investigate the precise causes of EVALI, but there is much that remains unclear, Seth Kligerman, MD, with UC San Diego School of Medicine, and colleagues wrote. It is evident, however, that most patients are young adult and adolescent men, with more than 80% of afflicted individuals reporting that they've vaped THC- or CBD-containing compounds.

Radiologists can turn to pulmonary imaging to accurately identify the condition, which may in turn, help save lives.

“Radiologists must be aware of the clinical manifestations and imaging findings of electronic cigarette or EVALI and should consider these when interpreting and reporting imaging studies of patients who present with acute respiratory illnesses or distress,” Kligerman and co-authors wrote in the study. “Although the imaging findings of EVALI overlap with other causes for similar patterns of acute lung injury, in the correct clinical context, radiologists can strongly suggest EVALI as a consideration.”

Those with the vaping-associated injury often have a combination of respiratory and gastrointestinal symptoms, along with more general maladies like fever or fatigue. And when performing chest CT scans, EVALI can appear variable, but typically images will reveal a pattern of diffuse lung injury with sparing of the periphery of the lungs, the authors noted. To be diagnosed, a patient must have a history of vaping within the past 90 days and abnormal findings on chest scans.

Eliminating other potential causes for a patient’s symptoms is also crucial, which means spotting EVALI is more a “diagnosis of exclusion,” Kligerman said in a statement.

He went on to note that some recent studies have demonstrated an association between vaping and the development of asthma, chronic bronchitis and chronic obstructive pulmonary disease. But these insights have only proven association, not causation. Some individuals, Kligerman said, even improve quickly after receiving corticosteroids.

Further research with long-term follow-up will be required to better understand EVALI, the researchers noted.

“Right now, we do not know the long-term effects of vaping, as it is still a relatively new method of nicotine and THC delivery, and there are countless variables involved which further confound our understanding of what is happening on a patient-specific level,” Kligerman stated.