Vaping Lung Injury Diagnosis May Be Aided By Identification of CT Scan Patterns: Study

A new study appears to have identified a unique patter on CT scans for individuals suffering from a vaping lung injury, which has resulted in thousands of hospitalizations nationwide and dozens of deaths.

In findings published this week in the medical journal Radiology: Cardiothoracic Imaging, researchers with the Mayo Clinic indicate that this new pattern may speed up process for diagnosing the vaping lung disease, and help avoid invasive biopsies to confirm the condition.

More than 3,000 hospitalized electronic cigarette or vaping product use-associated lung injury (EVALI) cases were reported to the U.S. Centers for Disease Control and Prevention (CDC) in a period of six months last year. There were 68 confirmed deaths as a result of the illnesses, which are believed to be primarily a result of using e-cigarettes containing vitamin E acetate or THC.

Last year, pathologists at Mayo Clinic in Arizona published research describing a pattern of lung injury in young people who use vape products. The pattern revealed injuries wrapped around the bronchi; the tubes that branch off the trachea into the lungs.

Expanding from that study, Mayo Clinic researchers looked for patterns on chest CT scans that might correlate with the previously observed findings.

The study included 26 patients who met EVALI criteria and underwent CT and biopsy. The three criteria to define EVALI include e-cigarette use within 90 days from symptom onset, abnormalities on chest imaging, and exclusion of other potential sources of injury like infection.

Researchers classified CT scan patterns according to different recognized patterns such as ground glass opacity, which is a term describing an area on the CT scan that appears whiter than normal but does not obscure the underlying structure of the lung, and consolidation, which is denser white areas on CT scans.

Other patterns include those indicating subacute hypersensitivity pneumonitis, or inflammation of lung tissues.

Researchers determined ground glass is the most common pattern seen among EVALI patients.

This is especially important since the emergence of the global pandemic of COVID-19. Many doctors continue to mistake vaping lung injuries, which are characterized by shortness of breath, for COVID-19 which also is characterized by similar symptoms. Understanding CT imaging in the context of COVID-19 or EVALI may prevent invasive biopsies and misdiagnosis.

In addition to helping identify cases, the new data indicated signs of EVALI on CT imaging resolved quickly after patients stopped vaping and took corticosteroid therapy.

The findings of the study could provide doctors with a new diagnostic tool to treat young patients who have symptoms of chest pain and shortness of breath without invasive procedures, like biopsy.

Lung biopsies carry some risk of complication, as well as considerable expense and anxiety for young patients. If doctors can make the diagnosis through imaging instead of invasive options like biopsies, it can help change treatment times as well.