Special report: Radiology's efforts will be ‘crucial’ for understanding vaping-related lung injury

A new report published in Radiology: Cardiothoracic Imaging offers guidance for radiologists to help identify vaping product use-associated lung injury (EVALI).

To date, there have been 1,604 cases of EVALI across 49 U.S. states, the District of Columbia and one U.S. territory, with 34 deaths. Authors of this new report analyzed recent cases and point to some of the imaging findings associated with lung injury in hopes of raising radiologists’ awareness and shedding light on these injuries.

“At this point, it’s a cloudy situation where you know the correlation between the behavior and the entity, but you don’t know exactly how the pieces are fitting together, or if you have a specific agent that is causing this,” report author Fernando Uliana Kay, MD, PhD, from UT Southwestern Medical Center’s Department of Radiology, said in an interview. “It’s still a work in progress. That’s the main factor that might be causing some anxiety or uncertainty for radiologists.”

The Centers for Disease Control and Prevention, FDA and state and local health departments are investigating recent outbreaks, but Kay and colleagues maintain that it is “crucial” radiologists lead research efforts to better understand the underlying causes of the disease, how to identify it, and how to improve the diagnosis and management of those with vaping history.

Radiologists, and all clinicians, should look for the following criteria when screening for potential cases of EVALI: e-cigarette or dabbing use within 90 days before symptoms begin; pulmonary opacities on chest x-rays or ground-glass opacities on chest CTs; no pulmonary infection at initial workup; and no evidence of another alternative diagnoses.

According to the special report, research into these injuries should be a collaborative effort, utilizing specialists across healthcare, including pathologists, epidemiologists, pulmonologists and emergency physicians.

"Radiologists will continue to play an important role in recognizing this emerging entity," co-author Suhny Abbara, MD, editor of Radiology: Cardiothoracic Imaging, said in a statement. "We encourage the medical imaging community to produce scientific evidence and medical knowledge to help advance our collective understanding of the effects of e-cigarette use on the lungs and other organ systems."

The CDC offered interim guidance on EVALI for healthcare providers on Oct. 11, and the American Journal of Roentgenology published a detailed study Oct. 8, which explores patterns that radiologists should look out for in practice.