On examination, 55% of patients were noted to be tachycardic, 45% were noted to be tachypneic, and 57% had saturations on room air of less than 95%. By and large, pulmonary findings on auscultation were unremarkable, even among those with severe lung injury.
Laboratory findings are fairly nonspecific, with 87% of patients having a WBC of greater than 11 000 and 93% with elevated ESR greater than 30 mm/hr. Half of patients (50%) have elevated liver transaminases (aspartate transaminase / alanine transaminase [AST / ALT] greater than 35 U/L).
All patients with symptoms compatible with EVALI should have a chest x-ray in the case of mild symptoms and a chest CT in the case of more severe symptoms or oxygen saturation less than 95% on room air. Radiographic findings of EVALI included infiltrates on chest x-ray and opacities on chest CT but were nonspecific. Chest x-ray most commonly shows bilateral hazy opacities with central sparing, and chest CTs classically show bilateral ground glass opacities of both lungs, most often bibasilar.
EVALI remains a diagnosis of exclusion, as no specific test or marker exists for diagnosis. All patients with compatible symptoms should be asked about vaping device use in the 3 months preceding symptom onset.
Patients should be evaluated for alternative etiologies including viral respiratory tract infections (eg, influenza) and common etiologies of community-acquired pneumonia (eg, Streptococcus pneumoniae, Mycoplasma pneumoniae, Legionella pneumophila).
Hypoxic patients and those in respiratory distress warrant hospitalization, and patients with even mild symptoms can deteriorate rapidly over 48 hours. Some patients, particularly those older than 50 years, may progress to respiratory failure, necessitating endotracheal intubation and mechanical ventilation.
Patients with EVALI and a history of asthma or other respiratory disease, cardiac disease, a mental health condition, or obesity may be at increased risk of death.
Related topics: cannabis use disorder, synthetic cannabinoid poisoning, nicotine dependence
J68.0 – Bronchitis and pneumonitis due to chemicals, gases, fumes and vapors
J69.1 – Pneumonitis due to inhalation of oils and essences
U07.0 – Vaping-related disorder
1148819003 – Injury of lung due to vaping
1148962001 – Injury of lung due to electronic cigarette use
Differential Diagnosis & Pitfalls
- Viral LRTIs, including influenza and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)
- Cryptogenic organizing pneumonia
- Lipoid pneumonia
- Bacterial LRTIs (eg, Streptococcus pneumoniae pneumonia), including atypical etiologies (eg, Mycoplasma)
- Endemic mycoses (blastomycosis, coccidioidomycosis, histoplasmosis, paracoccidioidomycosis, penicilliosis, and sporotrichosis)
- Opportunistic infections in the setting of immunocompromise (eg, Pneumocystis jirovecii pneumonia in patients with HIV)
- Pulmonary edema
- Aspiration pneumonitis (see aspiration pneumonia)
- Acute respiratory distress syndrome (ARDS)
Drug Reaction Data