Not applicable, Occupational / Environmental hazards, Biological effects, Acute, eLearning, Complications, Digital radiography, CT, Respiratory system, Lung, eHealth, Chest
C. Kiel1, K. Kiel1, J. Stowell2, C. Rojas 2, R. Grage2, S. Sonavane2, P. J. Mergo2; 1Gainesville/US, 2Jacksonville/US
Findings and procedure details
We present an initial review of the Mayo Clinic experience of the pulmonary imaging manifestations associated with e-cigarette use. These findings are recently recognized and can mimic those of hypersensitivity pneumonitis, ARDS, organizing pneumonia and fibrosing-interstitial lung disease, most notably NSIP.
Over 75 patients have presented to the Mayo Clinic with histories and/or radiographic patterns of disease that were suspicious for possible cases of EVALI. In review of the medical records (with approval of the Institutional review board), ten patients have been identified to date with the diagnosis of EVALI at the Mayo Clinic.
We present the imaging findings here of five of these patients. Please see Figures 6-23 for a full discussion of the imaging findings in these five patients.
In review of these cases, all patients had radiographic patterns which fit into one of the described four patterns of disease; organizing pneumonia, diffuse alveolar damage, diffuse alveolar hemorrhage and centrilobular nodularity. Additionally, most all patients also demonstrated the finding of sub-pleural sparing of disease.
The second patient in this series (Figures 12-15) was a 71 year old female. The initial radiographic pattern was thought to be concerning for possible EVALI, but the diagnosis was not included in the diagnostic report initially, due to the consideration of the age of the patient. This case highlights the fact that while EVALI is seen most commonly seen in young adults, often males, patients outside of the usual demographic parameters can also unexpectantly present with EVALI.
One patient, a 26 year old male (Figures16-19) experienced respiratory arrest during his hospitalization with successful resuscitation following intubation. He was subsequently extubated and recovered fully.
The characterization of this group of patients is preliminary and ongoing and the imaging findings and clinical course, along with pathologic correlation when available, will be reported in upcoming investigations.