Case of e-cigarette or vaping product use-associated lung injury (EVALI) in London, UK

2021 ◽  
Vol 14 (4) ◽  
pp. e240700
Author(s):  
Ruth Elizabeth Evans ◽  
Sophie Herbert ◽  
William Owen ◽  
Deepak Rao
Keyword(s):  
Vitamin E ◽  
Lung Injury ◽  
Synergistic Effect ◽  
Respiratory Disease ◽  
Corticosteroid Treatment ◽  
Shortness Of Breath ◽  
X Ray ◽  
Product Use ◽  
Vitamin E Acetate ◽  
Chest X Ray

We present a case of a 38-year-old man with no medical comorbidities who presented to the hospital with haemoptysis and shortness of breath on a background of vaping home-manufactured cannabis oil. He developed e-cigarette or vaping product use-associated lung injury (EVALI) visible on chest X-ray requiring oxygen, and corticosteroid treatment before making a recovery. Research reports that the contents vitamin E acetate and tetrahydrocannabinol are frequently found in substances acquired from informal sources which increase the likelihood of EVALI developing. Further research into their synergistic effect is ongoing. Although safer than smoking, vaping is not risk free and EVALI should be considered in patients presenting with respiratory disease.

scholarly journals E‐cigarette or Vaping Product Use–Associated Lung Injury Produced in an Animal Model From Electronic Cigarette Vapor Exposure Without Tetrahydrocannabinol or Vitamin E Oil

2020 ◽  
Vol 9 (18) ◽  
Author(s):  
Michael T. Kleinman ◽  
Rebecca Johnson Arechavala ◽  
David Herman ◽  
Jianru Shi ◽  
Irene Hasen ◽  
...  
Keyword(s):  
Vitamin E ◽  
Lung Injury ◽  
Inflammatory Cells ◽  
The United States ◽  
Electronic Cigarette ◽  
Alveolar Wall ◽  
Cigarette Use ◽  
Shortness Of Breath ◽  
Product Use ◽  
Vitamin E Acetate

Abstract E‐cigarette or vaping product use–associated lung injury was recognized in the United States in the summer of 2019 and is typified by acute respiratory distress, shortness of breath, chest pain, cough, and fever, associated with vaping. It can mimic many of the manifestations of coronavirus disease 2019 (COVID‐19). Some investigators have suggested that E‐cigarette or vaping product use–associated lung injury was due to tetrahydrocannabinol or vitamin E acetate oil mixed with the electronic cigarette liquid. In experimental rodent studies initially designed to study the effect of electronic cigarette use on the cardiovascular system, we observed an E‐cigarette or vaping product use–associated lung injury‐like condition that occurred acutely after use of a nichrome heating element at high power, without the use of tetrahydrocannabinol, vitamin E, or nicotine. Lung lesions included thickening of the alveolar wall with foci of inflammation, red blood cell congestion, obliteration of alveolar spaces, and pneumonitis in some cases; bronchi showed accumulation of fibrin, inflammatory cells, and mucus plugs. Electronic cigarette users should be cautioned about the potential danger of operating electronic cigarette units at high settings; the possibility that certain heating elements may be deleterious; and that E‐cigarette or vaping product use–associated lung injury may not be dependent upon tetrahydrocannabinol, vitamin E, or nicotine.

scholarly journals Simultaneous Temperature Measurements and Aerosol Collection During Vaping for the Analysis of Δ9-Tetrahydrocannabinol and Vitamin E Acetate Mixtures in Ceramic Coil Style Cartridges

2021 ◽  
Vol 9 ◽  
Author(s):  
John Lynch ◽  
Lisa Lorenz ◽  
Jana L. Brueggemeyer ◽  
Adam Lanzarotta ◽  
Travis M. Falconer ◽  
...  
Keyword(s):  
Thermal Decomposition ◽  
Vitamin E ◽  
Lung Injury ◽  
Temperature Measurements ◽  
Decomposition Products ◽  
Product Use ◽  
Vitamin E Acetate ◽  
Mean Temperature ◽  
Percent Recovery ◽  
Ft Ir

Incidence of e-cigarette, or vaping, product use-associated lung injury (EVALI) has been linked to the vaping of tetrahydrocannabinol (THC) products to which vitamin E acetate (VEA) has been added. In this work we vaped THC/VEA mixtures at elevated power levels using a variety of ceramic coil vaping cartridges and a commercially available vaping device, while simultaneously measuring temperature and collecting the vaporized condensate. The collected vapor condensate was analyzed for evidence of VEA decomposition by GC/MS, GC/FT-IR/MS, and LC-APCI-HRMS/MS. Mean temperature maxima for all examined cartridges at the selected power exceeded 430°C, with a range of 375–569°C, well beyond that required for thermal decomposition of VEA. The percent recovery of VEA and Δ9-THC from the vaporized mixture in six cartridges ranged from 71.5 to 101% and from 56.4 to 88.0%, respectively. Analysis of the condensed vaporized material identified VEA decomposition products duroquinone (DQ), 1-pristene, and durohydroquinone monoacetate (DHQMA); a compound consistent with 4-acetoxy-2,3,5-trimethyl-6-methylene-2,4-cyclohexadienone (ATMMC) was also detected. The concentration of DQ produced from vaporization of the THC/VEA mixture in one cartridge was found to be 4.16 ± 0.07 μg per mg of vapor condensate.

Acute Mitral Regurgitation: an important cause of respiratory distress

2016 ◽  
Vol 15 (1) ◽  
pp. 30-32
Author(s):  
Legate Philip ◽  
◽  
Neil Andrews ◽  
Keyword(s):  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Respiratory Distress ◽  
Severe Mitral Regurgitation ◽  
Shortness Of Breath ◽  
Valve Repair ◽  
X Ray ◽  
Clinical Presentations ◽  
Acute Mitral Regurgitation ◽  
Chest X Ray

Acute mitral regurgitation (acute MR) is a rare cause of acute respiratory distress, which can present diagnostic challenges. We present the case of a 57 year old man who developed acute shortness of breath subsequently associated with fever, raised white cells and elevated CRP. Chest x-ray revealed unilateral shadowing and he was treated for pneumonia, despite the finding of severe mitral regurgitation on echo. Failure to respond to antibiotic treatment following 3 weeks on ITU led to the consideration of acute MR as the cause of his symptoms and he responded well to diuretics. He subsequently underwent mitral valve repair. The causes and clinical presentations of this condition are discussed.

scholarly journals Transfusion-related acute lung injury (TRALI) in two thalassaemia patients caused by the same multiparous blood donor

2017 ◽  
Vol 9 (1) ◽  
pp. e2017060
Author(s):  
George J Kontoghiorghes
Keyword(s):  
Acute Lung Injury ◽  
Lung Injury ◽  
Blood Donor ◽  
Intensive Therapy ◽  
Hla Antigens ◽  
Hla Class I ◽  
Intensive Therapy Unit ◽  
X Ray ◽  
Red Blood Cell Transfusions ◽  
Chest X Ray

Two separate episodes of transfusion-related acute lung injury (TRALI) in thalassaemia patients caused by red blood cell transfusions from the same multiparous blood donor are reported. Both cases had the same symptomatology and occurred 10-60 minutes of transfusion. The patients presented dyspnea, sweating, fatigue, dizziness, fever, and sense of losing consciousness. The chest x-ray showed a pulmonary oedema-like picture with both lungs filled with fluid. The patients were treated in the intensive therapy unit. They were weaned off the ventilator and discharged following hospitalization 7 and 9 days respectively. The TRALI syndrome was diagnosed to be associated with HLA-specific donor antibodies against mismatched HLA-antigens of the transfused patients. Haemovigilance improvements are essential for reducing the morbidity and mortality in transfused patients. Blood from multiparous donors should be tested for the presence of IgG HLA-Class I and –Class II antibodies before being transfused in thalassaemia and other chronically transfused patients.

Woman in her 50s with shortness of breath on exertion

Heart ◽  
2018 ◽  
Vol 105 (2) ◽  
pp. 110-110
Author(s):  
Takao Konishi ◽  
Hironori Murakami ◽  
Shinya Tanaka
Keyword(s):  
Tricuspid Regurgitation ◽  
Vena Cava ◽  
List Type ◽  
Shortness Of Breath ◽  
Supplementary Data ◽  
X Ray ◽  
Doppler Image ◽  
Chest X Ray ◽  
Supplementary Material ◽  
Axis View

Clinical introductionA 59-year-old woman visited an outpatient cardiology clinic due to shortness of breath on exertion. Physical examination showed no significant abnormality of vital signs. A III/VI systolic murmur was heard on the fourth intercostal space at the right sternal border. The majority of laboratory tests were normal. Chest X-ray showed a curved vessel shadow (figure 1A). Initial transthoracic echocardiography showed abnormal blood flow into the inferior vena cava (IVC) in the subxiphoid long axis view (figure 1B) and mild right heart dilatation (online supplementary figure 1). Transoesophageal echocardiography showed severe tricuspid regurgitation (online supplementary figure 2).Figure 1(A) Chest X-ray. (B) Colour Doppler image in the subxiphoid long axis view.Supplementary dataSupplementary dataQuestionWhat is the most likely underlying disease for the patient’s shortness of breath on exertion?Pulmonary arteriovenous fistula.Pulmonary arterial hypertension.Lung cancer.Partial anomalous pulmonary venous connection.Isolated tricuspid regurgitation.

scholarly journals Recurrent spontaneous pneumothorax in pregnancy-a case report

2021 ◽  
Vol 8 (11) ◽  
pp. 3449
Author(s):  
Muhammad S. Shafique ◽  
Fatima Rauf ◽  
Hamza W. Bhatti ◽  
Noman A. Chaudhary ◽  
Muhammad Hanif
Keyword(s):  
Case Report ◽  
Spontaneous Pneumothorax ◽  
Respiratory Illness ◽  
Tube Thoracostomy ◽  
Shortness Of Breath ◽  
Past Medical History ◽  
Pleuritic Chest Pain ◽  
X Ray ◽  
Chest X Ray ◽  
In Pregnancy

Spontaneous pneumothorax during pregnancy is a rare but a serious condition. The typical symptoms of spontaneous pneumothorax include pleuritic chest pain and shortness of breath. Diagnosis is usually made on chest X-ray with abdominal shielding. Management differs according to severity and no specific guidelines are described for management of spontaneous pneumothorax in pregnancy. We report a case of a 27-year-old multigravida, with insignificant past medical history for any respiratory illness, presenting with recurrent, left sided spontaneous pneumothorax during a single pregnancy. It was managed by chest tube thoracostomy each time and patient was discharged with tube till the delivery of the fetus.

scholarly journals Chemical constituents involved in e-cigarette, or vaping product use-associated lung injury (EVALI)

2020 ◽  
Author(s):  
Thivanka Muthumalage ◽  
Michelle R. Friedman ◽  
Matthew D. McGraw ◽  
Alan E. Friedman ◽  
Irfan Rahman
Keyword(s):  
Lung Injury ◽  
Chemical Constituents ◽  
Lavage Fluid ◽  
Product Use ◽  
Vitamin E Acetate ◽  
Icp Ms ◽  
High Incidence ◽  
Conjugated Compounds ◽  
Liquid And Vapor Phases ◽  
Medical Grade

AbstractBackgroundThe Centers for Disease Control (CDC) declared e-cigarette (e-cig), or vaping product use-associated lung injury (EVALI) a national outbreak due to the high incidence of emergency department admissions and deaths. Investigators have identified vitamin E acetate (VEA) as the plausible cause for EVALI, based on compounds found in bronchoalveolar lavage fluid.ObjectivesWe defined the chemical constituents present in e-cig cartridges associated with EVALI and compared constituents to medical-grade and cannabidiol (CBD) containing cartridges.MethodsWe measured chemicals and elemental metals in e-liquid and vapor phases of e-cig counterfeit cartridges by Gas Chromatography (GC) and Mass Spectrometry (MS), EPA method TO-15 by GCMS, and ICP-MS analysis.ResultsWe have identified chemical constituents in e-cig vaping tetrahydrocannabinol (THC)-containing counterfeit cartridges compared to medical-grade and cannabidiol (CBD) containing cartridges. Apart from VEA and THC, other potential toxicants correlated with EVALI included solvent-derived hydrocarbons, silicon conjugated compounds, various terpenes, pesticides/plasticizers/polycaprolactones, and metals. These chemicals are known to cause symptoms, such as cough, shortness of breath or chest pain, nausea, vomiting or diarrhea, fatigue, fever, or weight loss, all symptoms presenting in patients with EVALI.ConclusionThis study provides insights into understanding the chemical-induced disease mechanism of acute lung injury.

scholarly journals An Animal Model of Inhaled Vitamin E Acetate and EVALI-like Lung Injury

2020 ◽  
Vol 382 (12) ◽  
pp. 1175-1177 ◽  
Author(s):  
Tariq A. Bhat ◽  
Suresh G. Kalathil ◽  
Paul N. Bogner ◽  
Benjamin C. Blount ◽  
Maciej L. Goniewicz ◽  
...  
Keyword(s):  
Animal Model ◽  
Vitamin E ◽  
Lung Injury ◽  
Vitamin E Acetate

scholarly journals Review of Cases of E-Cigarette or Vaping Product Use-Associated Lung Injury (EVALI) and Brief Review of the Literature

2020 ◽  
Vol 2020 ◽  
pp. 1-7
Author(s):  
Amr Essa ◽  
Jeffrey Macaraeg ◽  
Nikhil Jagan ◽  
Daniel Kwon ◽  
Saboor Randhawa ◽  
...  
Keyword(s):  
United States ◽  
Lung Injury ◽  
The United States ◽  
Cigarette Use ◽  
Review Of The Literature ◽  
The Past ◽  
Product Use ◽  
Vitamin E Acetate ◽  
Pathologic Features ◽  
Growing Body

Since the appearance of the E-Cigarette in the early 2000s, its industry, popularity, and prevalence have risen dramatically. In the past, E-Cigarette use with the vaping of nicotine or cannabis products had been associated with a few reported cases of lung injury. However, in 2019, thousands of cases of E-Cigarette or vaping product use-associated lung injury (EVALI) were reported in the United States. Evidence linked this outbreak with vaping of tetrahydrocannabinol (THC). We report two confirmed cases of EVALI and their associated clinical, radiologic, and pathologic features. This report supports the growing body of information regarding EVALI. It also discusses various substances, particularly vitamin E acetate, which has been suggested as a causative agent.

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