Pediatric chest radiographic and CT findings of electronic cigarette or vaping product use–associated lung injury (EVALI)

Background: Electronic cigarette or vaping product use–associated lung injury (EVALI) is a serious public health concern with substantial morbidity and mortality, particularly in young individuals. Purpose: To evaluate chest radiographic and chest CT findings of EVALI in the pediatric population. Materials and Methods: This was a retrospective study of children who presented to a tertiary pediatric hospital from December 2018 to December 2019. Patients fulfilled the Centers for Disease Control and Prevention criteria for EVALI and had chest radiographs and CT images available at initial presentation. Two pediatric radiologists independently reviewed imaging for pattern, distribution, and extent of pulmonary abnormalities, as well as for extrapulmonary abnormalities. Clinical information, management, and outcomes were reviewed. Interobserver agreement was measured with Cohen k coefficient. Results: Seven male patients (50%) and seven female patients (50%) (mean age, 16 years; range, 13–18 years) were evaluated. All patients underwent chest radiography and CT within 4 days of presentation (range, 0–4 days). Chest radiographic findings included ground-glass opacity in 14 of 14 (100%) and consolidation in eight of 14 (57%). CT findings included ground-glass opacity in 14 of 14 (100%), consolidation in nine of 14 (64%), and interlobular septal thickening in two of 14 (14%). At CT, subpleural sparing was seen in 11 of 14 (79%) and a reversed halo sign was seen in five of 14 (36%). Chest radiographic and CT abnormalities were predominately bilateral in 14 of 14 (100%) and symmetric in 13 of 14 (93%), with lower lobe predominance in seven of 14 (50%). Extent of abnormality was predominately diffuse at both chest radiography and CT. There was almost perfect interobserver agreement between two reviewers for detecting abnormalities on chest radiographs (k = 0.99; 95% confidence interval: 0.97, 1.00) and CT (k = 0.99; 95% confidence interval: 0.98, 1.00). Conclusion: In pediatric patients, electronic cigarette or vaping product use–associated lung injury is characterized by bilateral symmetric ground-glass opacities, consolidation, and a lower lobe predominance at CT.