E-cigarette, or vaping, product use Associated Lung Injury (EVALI): new scenarios for physicians and radiologists

A 59-year-old female ex-smoker with 40 pack year smoking history and a 5-year current e-cigarette (EC) use history, presented with progressive dyspnea on exertion and daily cough for 2 months. A CT scan showed a consolidation area with air bronchogram in the middle lobe and non-calcific bilateral nodules, which could be attributed to community-acquired pneumonia. The patient was treated with empiric antibiotics and systemic steroids for 10 days. Infectious, neoplastic and autoimmune pathologies were excluded, whereas a broncho-alveolar lavage revealed an accumulation of lipids in the cytoplasm of the alveolar macrophages. Despite the recommendation of vaping cessation, the patient continued to use EC. A new CT exam, carried out after 18 months, showed reversed halo sign (RHS), patchy ground-glass opacity (GGO), pleuro-parenchymal bands, and indeed perilobular pattern, suggestive of organizing pneumonia (OP). The final diagnosis was E-cigarette, or vaping, product use Associated Lung Injury (EVALI)- related OP.

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El Signo De Halo Invertido En Tomografía Computada De Tórax [The Inverted Halo Sign in Thoracic Computed Tomography]

Revista Médica de Panamá - ISSN 2412-642X ◽

10.37980/im.journal.rmdp.2020832 ◽

2020 ◽

Vol 40 (1) ◽

Author(s):

Rolando Reyna ◽

Karen Souza

Keyword(s):

Fungal Infections ◽

Ground Glass Opacity ◽

Pneumocystis Pneumonia ◽

Community Acquired Pneumonia ◽

Wegener Granulomatosis ◽

Lipoid Pneumonia ◽

Halo Sign ◽

Thoracic Computed Tomography ◽

Wide Range ◽

Reversed Halo Sign

ResumenEl signo del halo invertido se caracteriza por una opacidad central de vidrio esmerilado rodeado por una consolidación del espacio aéreo más densa en forma de una media luna o un anillo. El signo del halo invertido se ha informado en asociación con un amplia gama de enfermedades pulmonares, incluidas las infecciones fúngicas pulmonares invasivas, neumonía por pneumocystis, tuberculosis, neumonía adquirida en la comunidad, granulomatosis linfomatoide, granulomatosis de Wegener, neumonía lipoidea y sarcoidosis. También se observa en neoplasmas pulmonares e infarto y después de radioterapia y ablación por radiofrecuencia de neoplasias malignas pulmonares. También es conocido como signo de halo en reversa o signo del atolón.AbstractThe reversed halo sign is characterized by a central ground-glass opacity surrounded by denser air–space consolidation in the shape of a crescent or a ring. The reversed halo sign has been reported in association with a wide range of pulmonary diseases, including invasive pulmonary fungal infections, pneumocystis pneumonia, tuberculosis, community-acquired pneumonia, lymphomatoid granulomatosis,Wegener granulomatosis, lipoid pneumonia and sarcoidosis. It is also seen in pulmonary neoplasms and infarction, and following radiation therapy and radiofrequency ablation of pulmonary malignancies. It is also known as a reverse halo sign or atoll sign.

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Drug Induced Pneumonitis Secondary to Treatment with Paritaprevir/Ritonavir/Ombitasvir and Dasabuvir (VIEKIRA PAK®) for Chronic Hepatitis C: Case Report of an Unexpected Life-Threatening Adverse Reaction

Case Reports in Medicine ◽

10.1155/2017/4895736 ◽

2017 ◽

Vol 2017 ◽

pp. 1-5 ◽

Cited By ~ 4

Author(s):

Shih Yea Sylvia Wu ◽

Bridget Faire ◽

Edward Gane

Keyword(s):

Chronic Hepatitis ◽

Hepatitis C ◽

Chronic Hepatitis C ◽

Kidney Injury ◽

Complete Recovery ◽

Final Diagnosis ◽

Community Acquired Pneumonia ◽

Drug Induced ◽

First Case ◽

Life Threatening

VIEKIRA PAK (ritonavir-boosted paritaprevir/ombitasvir and dasabuvir) is an approved treatment for compensated patients with genotype 1 (GT1) chronic hepatitis C virus (HCV) infection. This oral regimen has minimal adverse effects and is well tolerated. Cure rates are 97% in patients infected with HCV GT 1a and 99% in those with HCV GT 1b. We report the first case of life-threatening allergic pneumonitis associated with VIEKIRA PAK. This unexpected serious adverse event occurred in a 68-year-old Chinese female with genotype 1b chronic hepatitis C and Child-Pugh A cirrhosis. One week into treatment with VIEKIRA PAK without ribavirin, she was admitted to hospital with respiratory distress and acute kidney injury requiring intensive care input. She was initially diagnosed with community acquired pneumonia and improved promptly with intravenous antibiotics and supported care. No bacterial or viral pathogens were cultured. Following complete recovery, she recommenced VIEKIRA PAK but represented 5 days later with more rapidly progressive respiratory failure, requiring intubation and ventilation, inotropic support, and haemodialysis. The final diagnosis was drug induced pneumonitis.

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E-CIGARETTE OR VAPING PRODUCT USE-ASSOCIATED LUNG INJURY-ASSOCIATED THROMBOCYTOSIS AND KUPFFER CELL ACTIVATION: A CASE SERIES

CHEST Journal ◽

10.1016/j.chest.2020.08.1481 ◽

2020 ◽

Vol 158 (4) ◽

pp. A1645

Author(s):

Angelina Voronina ◽

Christian Castaneda ◽

Christopher Lee ◽

Anthony Smith

Keyword(s):

Lung Injury ◽

Kupffer Cell ◽

Cell Activation ◽

Case Series ◽

Product Use

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Clinical and Radiological Characteristics of E-cigarette or Vaping Product Use Associated Lung Injury

10.1542/peds.147.3_meetingabstract.997 ◽

2021 ◽

Author(s):

Ambika G. Chidambaram ◽

Rebecca A. Dennis ◽

David M. Biko ◽

Marcus Hook ◽

Julian Allen ◽

...

Keyword(s):

Lung Injury ◽

Product Use

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Clinical Features of E-cigarette, or Vaping, Product Use–Associated Lung Injury in Teenagers

PEDIATRICS ◽

10.1542/peds.2021-053843h ◽

2021 ◽

Vol 148 (Supplement 3) ◽

pp. S7-S8

Author(s):

Dylan T. Timberlake ◽

David Stukus

Keyword(s):

Lung Injury ◽

Clinical Features ◽

Product Use

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Features Based on Thin-section Computed Tomography Identify the Typeof lung Adenocarcinoma

10.21203/rs.3.rs-18082/v2 ◽

2020 ◽

Author(s):

Zhiqiang Li ◽

Hongwei Zheng ◽

Shanshan Liu ◽

Xinhua Wang ◽

Lei Xiao ◽

...

Keyword(s):

Computed Tomography ◽

Lung Adenocarcinoma ◽

Thin Section ◽

Ground Glass Opacity ◽

Smoking History ◽

Ground Glass ◽

Quantitative Aspect ◽

Adenocarcinoma In Situ ◽

Invasive Adenocarcinoma ◽

Pleural Invasion

Abstract Background: To investigate whether thin-section computed tomography (TSCT) features may efficiently guide the invasiveness basedclassification of lung adenocarcinoma. Methods: Totally, 316 lung adenocarcinoma patients (from 2011-2015) were divided into three groups: 56 adenocarcinoma in situ (AIS), 98 minimally invasive adenocarcinoma (MIA), and 162 invasive adenocarcinoma (IAC) according their pathological results. Their TSCT features, including nodule pattern, shape, pleural invasion, solid proportion, border, margin, vascular convergence, air bronchograms, vacuole sign, pleural indentation, diameter, solid diameter, and CT values of ground-glass nodules (GGN) were analyzed. Pearson’s chi-square test, Fisher’s exact test and One-way ANOVA were adopted tocomparebetweengroups. Receiver operating characteristic (ROC) analysis wereperformedto assess its value for prediction and diagnosis. Results: Patients with IAC were significantly elder than those in AIS or MIA group,and more MIA patients had a smoking history than AIS and IAC. No recurrence happened in the AIS and MIA groups, while 4.3% recurrences were confirmed in the IAC group. As for TSCT variables, we found AIS group showed dominantly higher 91.07%PGGN pattern and 87.50% round/oval nodules than that in MIA and IAC group. In contrast, MIA group showed more cases with undefined border and vascular convergence than AIS and IAC group. Importantly, IAC group uniquely showed higher frequency of pleural invasion compared with MIA and AIS group. The majority of patients (82.1%) in IAC group showed ≥ 50% solid proportion. We found diameter and solid diameter of the lesions were notably larger in the IAC group compared with AIS and MIA groupin quantitative aspect. In addition, for MGGNs, the CT values of ground-glass opacity (GGO) and ground-glass opacity solid portion (GGO-solid) were both higher in the IAC group than AIS and MIA. Finally, we also observed that smooth margin took a dominant proportion in the AIS group while most cases in the IAC group had a lobulate margin. Patients in MIA and IAC group shared higher level of air bronchograms and vacuole signs than AIS group. Conclusions: The unique features in different groups identified by TSCT had diagnosis value for lung adenocarcinoma.

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Abstract P134: ASSOCIATION OF HYPERTENSION WITH MORTALITY RISK IN PATIENTS WITH COVID 19 PNEUMONIA IN A HOSPITAL IN MEXICO CITY

Hypertension ◽

10.1161/hyp.76.suppl_1.p134 ◽

2020 ◽

Vol 76 (Suppl_1) ◽

Author(s):

José Martín Alanís Naranjo ◽

Gabriela Olguín Contreras ◽

Cristo Raymundo Ibarra Jaimes

Keyword(s):

Severe Pneumonia ◽

Ground Glass Opacity ◽

Cross Sectional Study ◽

Community Acquired Pneumonia ◽

P Value ◽

Cross Sectional ◽

Risk Of Mortality ◽

Chest X Ray ◽

Time Of Admission ◽

First Time

Introduction: The world is currently suffering from the outbreak of a pandemic caused by the SARS-CoV-2 coronavirus, which causes the disease called COVID-19. This disease was reported for the first time in Wuhan, Hubei Province, China, on December 31, 2019. Hypertension, diabetes and cardiovascular disease are common among patients with COVID-19. In Mexico, information on the association between COVID-19 and hypertension is scarce. Methods: This investigation was a descriptive, observational and cross-sectional study that included patients over 18 years of age who had been hospitalized with laboratory-confirmed COVID-19 between April 6, 2020, and May 6, 2020, and exhibited chest X-ray abnormalities (ground-glass opacity, interstitial alterations and/or multilobar infiltrate). Severity of pneumonia (severe vs. nonsevere) at the time of admission was defined using the community-acquired pneumonia guidelines of the American Thoracic Society (ATS). Results: Information was collected from 89 patients with COVID-19 pneumonia, 34 of whom (38.2%) were hypertensive. When studying risk factors in hypertensive patients and their degree of statistical association with risk of mortality, only the severity of pneumonia stood out. The association between severe pneumonia and mortality was statistically significant (OR: 10.9, CI 1.19-99.6, p value = 0.034). Conclusions: Severity of pneumonia upon admission can be regarded as a marker of adverse clinical outcome in hypertensive COVID-19 patients. Among hypertensive COVID-19 patients, in-hospital mortality was high (68%); such mortality was higher in our study than has been reported in other series worldwide.

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