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Electronic cigarette vaping product use is associated with lung injury in a 15-year-old adolescent

  • Hui-Hsien Pan
    Affiliations
    Department of Pediatrics, Chung Shan Medical University Hospital, Taichung, Taiwan

    School of Medicine, Chung Shan Medical University, Taichung, Taiwan
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  • Teng-Fu Tsao
    Affiliations
    School of Medicine, Chung Shan Medical University, Taichung, Taiwan

    Department of Medical Imaging, Chung Shan Medical University Hospital, Taichung, Taiwan
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  • Shih-Ming Tsao
    Affiliations
    School of Medicine, Chung Shan Medical University, Taichung, Taiwan

    Department of Internal Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan
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  • Hai-Lun Sun
    Affiliations
    Department of Pediatrics, Chung Shan Medical University Hospital, Taichung, Taiwan

    School of Medicine, Chung Shan Medical University, Taichung, Taiwan
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  • Ko-Huang Lue
    Correspondence
    Corresponding author. Department of Pediatrics, Chung Shan Medical University Hospital, 110, Sec. 1, Chien-Kuo N. Road, Taichung 40201, Taiwan.
    Affiliations
    Department of Pediatrics, Chung Shan Medical University Hospital, Taichung, Taiwan

    School of Medicine, Chung Shan Medical University, Taichung, Taiwan
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Open AccessPublished:June 04, 2022DOI:https://doi.org/10.1016/j.pedneo.2022.05.006
      A 15-year-2-month-old boy presented with progressive and persistent upper abdominal pain and productive cough for 3 days before admission. A physical examination revealed crackles in the right lung, a distended abdomen, and tenderness over the upper abdomen. A chest radiograph (Fig. S1a) and chest computed tomography scan revealed blunting of bilateral costophrenic angles and multiple infiltrative nodules in both lungs with sparing of the left upper lobe (Fig. S1b and c). Laboratory tests showed leukocytosis and an elevated C-reactive protein level.
      He complained of dyspnea on Day 3 with a SpO2 of 88% on room air; thus, an O2 cannula was administered at 3 L/min. The chest radiograph had progressed (Fig. 1a). We performed a bronchoscopy on Day 5, which revealed hypervascularity of the mucosa in the bronchus and bronchial trees. We did not detect any specific pathogen or malignant cells in the bronchoalveolar lavage fluid. The dyspnea improved, and we removed the O2 cannula on Day 6. The history of using electronic cigarette (e-cigarettes) for 4 years and cigarettes for weeks was determined by a psychological consultant. Methylprednisolone was prescribed beginning on Day 8 under the impression of e-cigarette-associated lung injury (EVALI). A chest radiograph showed no infiltrative nodules (Fig. 1b).
      Figure 1
      Figure 1(a) Chest radiograph on Day 3 shows progressive infiltration in both lungs and increased pleural effusion compared tothe previous radiograph. (b) Chest radiograph on Day 8 illustrates bilaterally clear lungs. No pleural effusion is evident.
      E-cigarettes have been used since 2004
      National Center for Chronic Disease Prevention and Health Promotion (US) Office on Smoking and Health
      E-cigarette use among youth and young adults: a report of the surgeon general.
      and the frequency of EVALI has increased with the increased use of e-cigarettes.
      • Thakrar P.D.
      • Boyd K.P.
      • Swanson C.P.
      • Wideburg E.
      • Kumbhar S.S.
      E-cigarette, or vaping, product use-associated lung injury in adolescents: a review of imaging features.
      The chest radiographic findings of these patients range from normal to nodular opacity, patchy alveolar opacity, or mixed interstitial and alveolar opacities with central and lower lung predominance.
      • Thakrar P.D.
      • Boyd K.P.
      • Swanson C.P.
      • Wideburg E.
      • Kumbhar S.S.
      E-cigarette, or vaping, product use-associated lung injury in adolescents: a review of imaging features.
      ,
      • Layden J.E.
      • Ghinai I.
      • Pray I.
      • Kimball A.
      • Layer M.
      • Tenforde M.W.
      • et al.
      Pulmonary illness related to E-cigarette use in Illinois and Wisconsin - final report.
      Our patient had increased infiltration with multiple infiltrative nodules. A previous study described the pulmonary computed tomography findings, including confluent ground-glass opacities, centrilobular ground-glass nodules, reticular interstitial opacities, air space opacities sparing the subpleural regions, bronchial wall thickening, and extrapulmonary findings, such as enlarged mediastinal or hilar lymph nodes, pleural effusion, and pericardial effusion.
      • Thakrar P.D.
      • Boyd K.P.
      • Swanson C.P.
      • Wideburg E.
      • Kumbhar S.S.
      E-cigarette, or vaping, product use-associated lung injury in adolescents: a review of imaging features.
      Our patient revealed multiple infiltrative nodular opacities in both lungs, with relative sparing of the left upper lobe with pleural effusion.

      Declaration of competing interest

      The authors declare that they have no conflict of interest.

      Appendix A. Supplementary data

      The following is/are the supplementary data to this article:
      • Figure 1

        (a) Chest radiograph of a 15-year-old male on Day 1 reveals increased infiltration in both lungs with multiple infiltrative nodular opacities. Blunting of bilateral costophrenic angles may be indicative of pleural effusion. (b) The axial thin-section computed tomography image at the level of the lower lungs exhibits consolidation with patchy ground-glass opacities. Small bilateral pleural effusion was detected, particularly on the right side. (c) The coronal image reveals ground-glass nodular opacities in both lungs with a spared left upper lobe.

      References

        • National Center for Chronic Disease Prevention and Health Promotion (US) Office on Smoking and Health
        E-cigarette use among youth and young adults: a report of the surgeon general.
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        • Thakrar P.D.
        • Boyd K.P.
        • Swanson C.P.
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        E-cigarette, or vaping, product use-associated lung injury in adolescents: a review of imaging features.
        Pediatr Radiol. 2020; 50: 338-344
        • Layden J.E.
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        • et al.
        Pulmonary illness related to E-cigarette use in Illinois and Wisconsin - final report.
        N Engl J Med. 2020; 382: 903-916