BACKGROUND There has been a recent increase in recognition of lung disease related to the use of electronic cigarettes (called "vaping"). These patients present with acute respiratory illness following exposure to vaporized cannabis or nicotine products and sometimes require hospitalization and intensive care. We describe the imaging findings of this disease entity in the pediatric population. OBJECTIVE To describe the radiologic findings of lung injury associated with electronic cigarette use (vaping) in the adolescent pediatric population. MATERIALS AND METHODS We identified all adolescents with acute respiratory illness and a history of electronic cigarette use who presented at our institution within a 3-month period (June 2019 through August 2019). We excluded adolescents with potential intercurrent pulmonary disease. We reviewed the charts for symptomatology and laboratory and pathology data. In addition, we reviewed the chest radiographs and chest CTs of these adolescents. RESULTS The review group consisted of 12 teenage pediatric patients (10 boys and 2 girls; mean age 16.9 years, range 16.0-17.7 years) with acute respiratory illness found to have a temporal association with electronic cigarette use for cannabis products, nicotine, or both. Other etiologies for illness in these adolescents had been excluded by clinical and laboratory evaluation. All of the adolescents were admitted to the hospital for treatment. The clinical presentations included dyspnea, abdominal pain and constitutional symptoms. Pulmonary function testing that was performed in all patients during admission or follow-up demonstrated reduced diffusion capacity in 4/12 (33%), an obstructive ventilatory pattern in 4/12 (33%), a restrictive pattern in 1/12 (8%), and a mixed obstructive and restrictive pattern in 2/12 (17%) adolescents. Bronchoalveolar lavage studies, performed in 9 of the 12 adolescents, revealed inflammatory cells and lipid-laden macrophages. All of the patients underwent CT of the chest; the findings were notable for centrilobular ground-glass nodules (11/12; 92%) and confluent ground-glass opacities (12/12; 100%), with frequent subpleural sparing (9/12; 75%). Additionally, 6/12 (50%) adolescents demonstrated small pleural effusions; 6/12 (50%) had mild bronchial wall thickening; 9/12 (75%) had enlarged hilar or mediastinal lymph nodes; and 2/12 (17%) had a small pericardial effusion. CONCLUSION As seen in our teenage population, e-cigarette, or vaping, product use-associated lung injury (EVALI) is characterized by centrilobular ground-glass nodules and ground-glass opacities with subpleural sparing. The imaging findings are most consistent with acute lung injury resulting from toxic inhalation. Because adolescent pediatric patients might not be forthcoming with their history of electronic cigarette use, it is important for the pediatric radiologist to be aware of the imaging patterns of this disease.

中文翻译：

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青少年电子烟（或电子烟）与产品使用相关的肺损伤：影像学特征的回顾。

背景技术近来，与使用电子烟有关的对肺部疾病的认识增加了（称为“吸气”）。这些患者在暴露于汽化大麻或尼古丁产品后出现急性呼吸系统疾病，有时需要住院和重症监护。我们描述了这种疾病在儿科人群中的影像学发现。目的描述青少年儿童人群与电子烟使用（吸烟）相关的肺部损伤的放射学表现。材料和方法我们确定了在三个月内（2019年6月至2019年8月）在我们机构就诊的所有急性呼吸系统疾病和有电子烟使用史的青少年。我们排除了潜在的并发肺部疾病的青少年。我们回顾了症状图以及实验室和病理学数据图表。此外，我们回顾了这些青少年的胸部X线照片和胸部CT。结果审查组包括12名青少年呼吸道疾病（平均年龄16.9岁，范围16.0-17.7岁）的青少年儿科患者（平均年龄16.9岁，范围16.0-17.7岁），发现其与使用大麻产品，尼古丁或两者同时使用电子烟存在时间关联。临床和实验室评估已排除了这些青少年的其他病因。所有青少年均入院接受治疗。临床表现包括呼吸困难，腹痛和体质症状。在入院或随访期间对所有患者进行的肺功能测试表明，扩散能力降低了4/12（33％），4/12（33％）的阻塞性通气模式，1/12（8％）的阻塞性通气模式和2/12（17％）的青少年混合性阻塞性和限制性模式。在12名青少年中有9名进行了支气管肺泡灌洗研究，结果显示炎性细胞和载脂类巨噬细胞。所有患者均接受了胸部CT检查。该发现对于小叶状毛玻璃样结节（11/12； 92％）和融合性毛玻璃样混浊（12/12; 100％）显着，并经常有胸膜下保留（9/12; 75％）。另外，有6/12（50％）的青少年表现出少量的胸腔积液。6/12（50％）的患者支气管壁轻度增厚；9/12（75％）的肺门或纵隔淋巴结肿大；和2/12（17％）的心包积液较小。结论从我们的青少年人口，电子烟或电子烟中可以看出，与产品使用相关的肺损伤（EVALI）的特征是小叶中心磨玻璃结节和玻璃膜混浊，伴有胸膜下保留。影像学发现与中毒吸入引起的急性肺损伤最一致。由于青少年儿科患者可能不会了解他们使用电子烟的历史，因此对于儿科放射科医生来说，了解这种疾病的成像模式非常重要。