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E2075. Radiological Findings in E-Cigarette Vaping-induced Lung Injury
Authors
  1. Carlos Romero Alaffita; Universidad Autonoma De San Luis Potosi
  2. Alberto Gudiño; Universidad Autonoma De San Luis Potosi
  3. Jacqueline Franco; Universidad Autonoma De San Luis Potosi
  4. Daniel Sandoval; Universidad Autonoma De San Luis Potosi
Background
Introduced in 2007 to the United States, there are currently about 300 different models and more than 15,000 flavors. For 2019, 215 cases of pulmonary disease associated with electronic cigarettes have been reported. Composed of a lithium battery, an interchangeable cartridge compartment and a mouthpiece Adolescents are the most frequent users with a 2:1 ratio, men vs women. Layden reported a series of 53 cases associated with electronic cigarettes, found 91% of the radiographs abnormal, and 100% of the tomographies with pathological findings. The most frequent findings were bilateral opacities in 100% of the patients, most of them respecting the subpleural space, 9% of the cases were associated with pneumomediastinum, 11% with pleural effusion and 2% with pneumothorax.

Educational Goals / Teaching Points
To know the proposed pathophysiological mechanisms that electronic nicotine delivery systems (electronic cigarettes) have on the human lung. Depict the epidemiology of E-cigarrete or vaping Use-Associated Lung Injury. Illustrate the main imaging findings in their different modalities of the E-cigarrete or vaping Use-Associated Lung Injury.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
Hypersensitivity pneumonia: Inflammatory disease resulting from an immune response to inhaled antigens, typically associated with microbial agents, proteins or chemicals, 2 cases have been reported associated with electronic cigarettes, the tomographic findings depend on its chronicity. Diffuse alveolar hemorrhage: results from damage to the alveolar microcirculation, it can be observed without acute radiographic abnormalities in 20-50% of the cases, when there are changes include ground glass opacities, without interlobular septal thickening, chronic changes include pulmonary fibrosis, with regions that show loss of architecture, and septal thickening. Lipoid pneumonia: Inflammatory response secondary to lipids, there are multiple cases associated with electronic cigarettes. Radiological findings include predominantly bilateral ground glass opacities at baseline, there may or may not be associated septal thickening, other reported findings were nodules, pneumatoceles, pneumomediastinum and pleural effusion. Acute eosinophilic pneumonia: The predominant findings are bilateral ground glass opacities frequently associated with consolidations and interlobular septal thickening, and also pleural effusion. Organized pneumonia: Lung injury secondary to fibroblast and collagen proliferation.Tomographic findings include ground glass opacities, with a tendency to consolidate bilaterally in a perilobular or peripheral distribution. The “reverse halo” sign will not always be present.

Conclusion
The use of electronic cigarettes has been associated with acute lung injuries despite not having a clear pathophysiology. It is of the utmost importance for the radiologist to know the characteristic patterns reported to announce to the clinician when suspecting said pathology. There is no regulation or agency that is properly in charge of the quality of such electronic devices and their diluents, which is why an adequate quality surveillance system is needed.