Radiologic and Pathologic Correlation in EVALI

Prasad M. Panse, Fionna F. Feller, Yasmeen M. Butt, Maxwell L. Smith, Brandon T. Larsen, Henry D. Tazelaar, Howard J. Harvin, Michael B. Gotway

Research output: Contribution to journalArticlepeer-review

1 Scopus citations


OBJECTIVE. The purpose of this article is to characterize the appearance on CT of e-cigarette or vaping product use–associated lung injury (EVALI) in a cohort with histopathologic evidence of this disorder. MATERIALS AND METHODS. Twenty-four patients with EVALI were identified. Chest CT examinations were reviewed by two radiologists for various chest CT findings. For comparison with pathologic findings, CT assessments were distilled into previously described patterns of EVALI seen on CT: acute lung injury (ALI), chronic eosinophilic pneumonia (CEP) or organizing pneumonia (OP), acute eosinophilic pneumonia (AEP), alveolar hemorrhage, hypersensitivity pneumonitis (HP), lipoid pneumonia, and mixed or unclassifiable patterns. RESULTS. Sixteen of 24 (67%) patients were men; the mean age was 34.5 years (range, 17–67 years). The most common CT finding was ground-glass opacities, which was present in 23 of 24 (96%) patients and the dominant finding in 18 of 24 (75%) patients. Consolidation was the next most common finding in 42% of patients. Interlobular septal thickening was present in 29%. Lobular low attenuation was conspicuous in six patients. Distribution was multifocal in 54% of patients, peripheral in 17%, and centrally predominant in 8%. Subpleural sparing was seen in 45%. The predominant CT pattern was ALI (42%), concordant with histopathologic findings in 75%; the next most predominant pattern was ground-glass opacity centrilobular nodules resembling HP (33%). A CT pattern of CEP or OP was seen in 13% of patients, all showing ALI on lung biopsy. No patient showed macroscopic lung parenchymal fat. Two patients with CT ALI patterns showed OP on histopathologic examination. Of the eight patients with ground-glass opacity centrilobular nodules resembling HP at CT, none showed HP at histopathologic examination. CONCLUSION. EVALI manifests at CT as ALI with multifocal ground-glass opacity, often with organizing consolidation, and a small centrilobular nodular pattern resembling HP.

Original languageEnglish (US)
Pages (from-to)1057-1064
Number of pages8
JournalAmerican Journal of Roentgenology
Issue number5
StatePublished - Nov 2020


  • Acute lung injury
  • E-cigarettes
  • Organizing pneumonia
  • Pneumonitis
  • Vaping

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging


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