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

Submitted: June 9, 2021
Accepted: October 6, 2021
Published: December 3, 2021
Abstract Views: 1593
PDF: 759
Publisher's note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.


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.



PlumX Metrics


Download data is not yet available.


Krishnasamy VP, Hallowell BD, Ko JY, et al. Update: Characteristics of a Nationwide Outbreak of E-cigarette, or Vaping, Product Use-Associated Lung Injury - the United States, August 2019-January 2020. MMWR Morb Mortal Wkly Rep 2020;24;69:90-4. DOI: https://doi.org/10.15585/mmwr.mm6902e2
Viswam D, Trotter S, Burge PS, Walters GI. Respiratory failure caused by lipoid pneumonia from vaping e-cigarettes. BMJ Case Rep 2018;6;2018:bcr2018224350. DOI: https://doi.org/10.1136/bcr-2018-224350
Fryman C, Lou B, Weber AG, et al. Acute respiratory failure associated with vaping. Chest 2020;157:e63-8. DOI: https://doi.org/10.1016/j.chest.2019.10.057
Rajagopala S, Selvam N. An unusual case of respiratory distress. J Postgrade Med 2019;65:38-40. DOI: https://doi.org/10.4103/jpgm.JPGM_496_17
Blount BC, Karwowski MP, Shields PG, et al. Vitamin E acetate in bronchoalveolar-lavage fluid associated with EVALI. N Engl J Med 2020;20;382:697-705. DOI: https://doi.org/10.7196/AJTCCM.2020.v26i1.058
Blount BC, Karwowski MP, Morel-Espinosa M, et al. Evaluation of bronchoalveolar lavage fluid from patients in an outbreak of e-cigarette, or vaping, product use-associated lung injury - 10 States, August-October 2019. MMWR Morb Mortal Wkly Rep 2019;15;68:1040-104. DOI: https://doi.org/10.15585/mmwr.mm6845e2
Kligerman S, Raptis C, Larsen B et al. Radiologic, pathologic, clinical, and physiologic findings of electronic cigarette or vaping product use-associated lung injury (EVALI): Evolving knowledge and remaining questions. Radiology 2020;294:491-505. DOI: https://doi.org/10.1148/radiol.2020192585
Henry TS, Kligerman SJ, Raptis CA, et al. Imaging findings of vaping-associated lung injury. AJR Am J Roentgenol 2020;214:498-505. DOI: https://doi.org/10.2214/AJR.19.22251
Epler GR. Bronchiolitis obliterans organizing pneumonia. Arch Intern Med 2001;161:158-64. DOI: https://doi.org/10.1001/archinte.161.2.158
American Thoracic Society, European Respiratory Society. American Thoracic Society/European Respiratory Society international multidisciplinary consensus classification of the idiopathic interstitial pneumonias. Am J Respir Crit Care Med 2002;15;165:277-304. DOI: https://doi.org/10.1164/ajrccm.165.2.ats01
Drakopanagiotakis F, Paschalaki K, Abu-Hijleh M, et al. Cryptogenic and secondary organizing pneumonia: clinical presentation, radiographic findings, treatment response, and prognosis. Chest 2011;139:893-900. DOI: https://doi.org/10.1378/chest.10-0883
Baque-Juston M, Pellegrin A, Leroy S, et al. Organizing pneumonia: what is it? A conceptual approach and pictorial review. Diagn Interv Imaging 2014;95:771-7. DOI: https://doi.org/10.1016/j.diii.2014.01.004
Khan MS, Khateeb F, Akhtar J, et al. Organizing pneumonia related to electronic cigarette use: A case report and review of literature. Clin Respir J 2018;12:1295-9. DOI: https://doi.org/10.1111/crj.12775
Jankharia B, Rajan S, Angirish B. Vaping associated lung injury (EVALI) as an organizing pneumonia pattern - A case report. Lung India 2020;37:533-5. DOI: https://doi.org/10.4103/lungindia.lungindia_69_20
Basarakodu KR, Aronow WS, Nair CK, et al. Differences in treatment and in outcomes between idiopathic and secondary forms of organizing pneumonia. Am J Ther 2007;14:422-6. DOI: https://doi.org/10.1097/01.pap.0000249905.63211.a1
Shields PG, Song MA, Freudenheim JL, et al. Lipid laden macrophages and electronic cigarettes in healthy adults. EBioMedicine 2020;60:102982. DOI: https://doi.org/10.1016/j.ebiom.2020.102982
Butt YM, Smith ML, Tazelaar HD et al. Pathology of vaping-associated lung injury. N Engl J Med 2019;381:1780-1. DOI: https://doi.org/10.1056/NEJMc1913069
Steinke JW, Borish L. Th2 cytokines and asthma. Interleukin-4: its role in the pathogenesis of asthma, and targeting it for asthma treatment with interleukin-4 receptor antagonists. Respir Res 2001;2:66-70. DOI: https://doi.org/10.1186/rr40
Branchett WJ, Lloyd CM. Regulatory cytokine function in the respiratory tract. Mucosal Immunol 2019;12:589-600. DOI: https://doi.org/10.1038/s41385-019-0158-0
Hansen MJ, Chan SP, Langenbach SY, et al. IL-17A and serum amyloid A are elevated in a cigarette smoke cessation model associated with the persistence of pigmented macrophages, neutrophils and activated NK cells. PLoS One 2014;18;9:e113180. DOI: https://doi.org/10.1371/journal.pone.0113180

How to Cite

Guarino, Carmine, Ilaria Pedicelli, Francesco Perna, Valentina Di Spirito, Giuseppe Fiorentino, Fabio Procaccini, and Gaetano Rea. 2021. “E-Cigarette, or Vaping, Product Use Associated Lung Injury (EVALI): New Scenarios for Physicians and Radiologists”. Monaldi Archives for Chest Disease 92 (3). https://doi.org/10.4081/monaldi.2021.1962.