E-cigarette or vaping product use-associated lung injury in the pediatric population: imaging features at presentation and short-term follow-up

Abstract Background: A cluster of patients with coronavirus disease 2019 (COVID-19) pneumonia were discharged from hospitals in Wuhan, China. We aimed to determine the cumulative percentage of complete radiological resolution at each time point, to explore the relevant affecting factors, and to describe the chest CT findings at different time points after hospital discharge.Methods: Patients with COVID-19 pneumonia confirmed by RT-PCR who were discharged consecutively from the hospital between 5 February 2020 and 10 March 2020 and who underwent serial chest CT scans on schedule were enrolled. The radiological characteristics of all patients were collected and analysed. The total CT score was the sum of non-GGO involvement determined at discharge. Afterwards, all patients underwent chest CT scans during the 1st, 2nd, and 3rd weeks after discharge. Imaging features and distributions were analysed across different time points.Results: A total of 149 patients who completed all CT scans were evaluated; there were 67 (45.0%) men and 82 (55.0%) women, with a median age of 43 years old (IQR 36-56). The cumulative percentage of complete radiological resolution was 8.1% (12 patients), 41.6% (62), 50.3% (75), and 53% (79) at discharge and during the 1st, 2nd, and 3rd weeks after discharge, respectively. Patients ≤44 years old showed a significantly higher cumulative percentage of complete radiological resolution than patients >44 years old at the 3-week follow-up. The predominant patterns of abnormalities observed at discharge were ground-glass opacity (GGO) (65 [43.6%]), fibrous stripe (45 [30.2%]), and thickening of the adjacent pleura (16 [10.7%]). Lung lesions showed obvious resolution from 2 to 3 weeks after discharge, especially in terms of GGO and fibrous stripe. “Tinted” sign and bronchovascular bundle distortion as two special features were discovered during the evolution.Conclusion: Lung lesions in COVID-19 pneumonia patients can be absorbed completely during short-term follow-up with no sequelae. Three weeks after discharge might be the optimal time point for early radiological estimation.

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Faculty Opinions recommendation of E-cigarette and vaping product use-associated lung injury in the pediatric population: A critical review of the current literature.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.739889618.793584544 ◽

2021 ◽

Author(s):

Neil Grunberg

Keyword(s):

Lung Injury ◽

Current Literature ◽

Critical Review ◽

Pediatric Population ◽

Product Use

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Clinicopathological and imaging features of lipoastrocytoma: Case report

The Neuroradiology Journal ◽

10.1177/1971400917710667 ◽

2017 ◽

Vol 31 (1) ◽

pp. 32-38

Author(s):

Laxminadh Sivaraju ◽

Saritha Aryan ◽

Nandita Ghosal ◽

Alangar S Hegde

Keyword(s):

Spinal Cord ◽

Central Nervous System ◽

Nervous System ◽

Pediatric Population ◽

Pleomorphic Xanthoastrocytoma ◽

Imaging Features ◽

Total Excision ◽

Favorable Prognosis ◽

The Central Nervous System

Lipidized tumors of the central nervous system are very uncommon, with only a few cases described. We report a case of a 25-year-old woman with a tumor involving the left premotor area. She underwent gross total excision. Histologically, the tumor was composed of glial fibrillary acidic protein-positive glial cells with areas of lipidization. A diagnosis of lipoastrocytoma was rendered. At three-year follow-up she was doing well, supporting the presumed favorable prognosis of these uncommon tumors. Absence of xanthochromic appearance, mitotic activity, necrosis and poor reticulin activity are the differentiating features from the pleomorphic xanthoastrocytoma. We highlighted that these tumors involve the adult and pediatric population and distribute in both supratentorial and infratentorial compartments as well as in the spinal cord.

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Short-Term Follow-Up of Palpable Breast Lesions With Benign Imaging Features: Evaluation of 375 Lesions in 320 Women

American Journal of Roentgenology ◽

10.2214/ajr.09.2811 ◽

2009 ◽

Vol 193 (6) ◽

pp. 1723-1730 ◽

Cited By ~ 66

Author(s):

Jennifer A. Harvey ◽

Brandi T. Nicholson ◽

Alexander P. LoRusso ◽

Michael A. Cohen ◽

Viktor E. Bovbjerg

Keyword(s):

Breast Lesions ◽

Imaging Features ◽

Short Term ◽

Palpable Breast

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Diagnosis and Acute Management of E-Cigarette or Vaping Product Use–Associated Lung Injury in the Pediatric Population: A Systematic Review

The Journal of Pediatrics ◽

10.1016/j.jpeds.2020.09.040 ◽

2021 ◽

Vol 228 ◽

pp. 260-270

Author(s):

Clarelle L. Gonsalves ◽

Jie Wei Zhu ◽

April J. Kam

Keyword(s):

Systematic Review ◽

Lung Injury ◽

Pediatric Population ◽

Acute Management ◽

Product Use

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E-cigarette, or vaping, product use-associated lung injury (EVALI) treated with veno-venous extracorporeal membrane oxygenation (VV-ECMO) and ultra-protective ventilator settings

BMJ Case Reports ◽

10.1136/bcr-2020-234771 ◽

2020 ◽

Vol 13 (7) ◽

pp. e234771

Author(s):

Mazen Faris Odish ◽

Amy Bellinghausen ◽

Eugene Golts ◽

Robert Llewellyn Owens

Keyword(s):

Lung Injury ◽

Extracorporeal Membrane Oxygenation ◽

Membrane Oxygenation ◽

Product Use ◽

Ventilator Induced Lung Injury ◽

Volume Ventilation ◽

Protective Mechanical Ventilation ◽

Vv Ecmo ◽

Lung Protective Mechanical Ventilation

A 19-year-old man vaping with tetrahydrocannabinol presented with dyspnoea and right pneumothorax. History, imaging and negative infectious workup were consistent with E-cigarette, or vaping, product use-associated lung injury (EVALI). Treated with systemic steroids, he developed acute respiratory distress syndrome and was intubated requiring veno-venous extracorporeal membrane oxygenation (VV-ECMO) by hospital day 3. Using VV-ECMO, very-low tidal volume ventilation of 1.5 cc/kg was achieved, as was daily ambulation. VV-ECMO was decannulated on hospital day 9 and the patient was extubated the next day. He was discharged home on hospital day 13 without oxygen. At post-intensive care unit clinic follow-up, he had lost 20 kg of weight while hospitalised and reported nightmares. Patients with EVALI may be supported with VV-ECMO, which allows ultra-lung-protective mechanical ventilation that may minimise ventilator-induced lung injury. Follow-up in patients with EVALI is essential to diagnose and treat comorbidities, follow lung function and prevent relapses.

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Clinical outcomes and lipid-laden macrophages in Electronic cigarette/Vaping product use-Associated Lung Injury (EVALI) in a South Texas population

Discussion of Clinical Cases ◽

10.5430/dcc.v8n1p1 ◽

2021 ◽

Vol 8 (1) ◽

pp. 1

Author(s):

Mahnoor Mir ◽

Moeezullah Beg ◽

Jay I. Peters ◽

Sandra G. Adams

Keyword(s):

Lung Injury ◽

Noninvasive Positive Pressure Ventilation ◽

Supplemental Oxygen ◽

Electronic Cigarette ◽

Positive Pressure ◽

Presenting Symptoms ◽

Product Use ◽

Systemic Corticosteroids ◽

History Of

Objective: To describe the clinical features, proportion of lipid-laden alveolar macrophages in bronchoalveolar lavage (BAL), and short-term and 6-month to 12-month outcomes of patients with Electronic cigarette/Vaping product use-Associated Lung Injury (EVALI).Methods: Retrospective review of clinical characteristics, radiographs, and BAL samples for all patients with a history of vaping who presented with acute hypoxemic respiratory failure to the University Hospital in San Antonio, Texas from 9/2019 to 6/2020 was performed.Results: We report 16 cases (15 men; median age, 30 years [range 19-75]) of EVALI with a history of vaping Tetrahydrocannabinol (THC), nicotine, or both. The most common presenting symptoms were tachycardia, dyspnea, cough, and fever. All patients required supplemental oxygen, including two who required noninvasive positive pressure ventilation, and five who required mechanical ventilation. All 16 patients had bilateral ground-glass opacities (GGO) with peripheral sparing on chest computerizedtomography (CT). Cultures were negative, except for one patient who tested positive for rhinovirus. COVID-19 PCR was done in one individual which was negative. Cytology demonstrated lipid-laden macrophages on Oil-Red-O stain on fresh (i.e., without fixative) BAL in the majority of patients (N = 12) with a mean lipid-saturation percentage of 78% [range, 44%-100%] and the mean Colombo count of 194 [range, 101-359]. Fifteen patients were treated with systemic corticosteroids. The median length of hospital stay was 10 days. At discharge, three patients required supplemental oxygen. Eight of those who had follow-up imaging showed resolution of GGO. One patient had a relapse of symptoms and was again treated with systemic corticosteroids and mycophenolate, with resolution of symptoms. Fourteen patients who were evaluated after discharge denied vaping post-discharge (two patients were not able to be contacted and did not keep follow-up appointments).Conclusions: Successful diagnosis and management of EVALI requires a high clinical suspicion, thorough evaluation to rule out infectious etiologies, and aggressive treatment with systemic corticosteroids, along with sustained abstinence from vaping.

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