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Doctors Use CT Scans to Diagnose and Manage Lung Disease Associated with Vaping

Doctors Use CT Scans to Diagnose and Manage Lung Disease Associated with Vaping

Electronic cigarettes, also known as e-cigarettes or "vaping," have been making the news lately. As of October 10, 2019, the CDC had linked vaping with 29 deaths and 1,299 lung injuries. The cases occurred in 49 states, the District of Columbia and the United States Virgin Islands. Illinois and California were the hardest hit, although states like Wisconsin and Pennsylvania also saw a large number of lung injuries and deaths associated with the use of vaping products. Doctors now use computed tomography (CT) scans to help diagnose lung damage associated with vaping. 

About Electronic Cigarettes

E-cigarettes are battery-operated devices that vaporize, or create an aerosol, by heating liquids. The liquids can contain nicotine, flavorings and even tetrahydrocannabinol (THC) and cannabinoid (CBD) oils. The liquid can also contain other substances that may be unstable when subjected to high heat, like that created with vaping. The consumer then inhales the aerosol into their lungs.

Electronic cigarettes have been around for a while. Herbert A. Gilbert introduced the first non-tobacco, smokeless device in 1967 as a safe alternative to smoking tobacco. Chinese pharmacist, Hon Lik, developed the first generation e-cigarette to use an electric element to vaporize diluted liquid nicotine. Hon Lik invented the device as a safer way to inhale nicotine after his father died of lung cancer. E-cigarettes found their way to the U.S. market in 2007. E-cigarettes became quite popular quickly and became a multi-billion dollar industry nearly overnight.

E-cigarettes had been on the market for years without incident, except for some burn injuries sustained when some of the devices exploded. Then, in 2019, reports lung damage among e-cigarette consumers started to emerge. The Illinois Department of Public Health (IDPH) reported the first death associated with vaping in August of 2019. Since that report, thousands of e-cigarette consumers have reported symptoms to their doctors.

Doctors diagnose vaping-related illnesses by talking to patients about their vaping use, assessing patient symptoms, and performing CT scans to evaluate lung damage. The CT scans show specific findings that help doctors understand the full extent of damage inflicted on the patient's lungs.

Researchers Reviewed CT Scan Results of People with Vaping-related Lung Damage – Here is What They Found

A team of researchers led by chief medical officer of the Illinois Department of Public Health Jennifer Layden, PhD, investigated 53 cases of vaping-related lung disease in Illinois and Wisconsin. They published their results in the New England Journal of Medicine in September of 2019.

All of the patients had used e-cigarettes within 90 days of developing symptoms. Most of the patients enrolled in the study had respiratory symptoms, but 81 percent had gastrointestinal symptoms. All had "constitutional symptoms," which are a group of symptoms that include weight loss, fevers, headaches, sweating, chronic pain, fatigue, shortness of breath and malaise. The patients also had similar clinical findings, and their lung injuries seemed to progress in the same way. This suggests that the illnesses had a common cause. The researchers speculate that the chemicals used in e-cigarette liquids were that common cause. They think the chemicals decompose when exposed to the heat produced by the e-cigarette. The breakdown of those chemicals produces new compounds that may damage tissue when inhaled into the lungs. The heating coils in the electronic cigarettes might also release zinc, manganese and other metals into the aerosol; these aerosolized metals can be toxic.

Alone or in combination with others, the substances released in e-cigarettes may cause a number of pulmonary illnesses that affect the lungs. These illnesses can include pneumonitis and pneumonia, acute metal fume fever, and polymer fume fever. In severe cases, patients may develop acute lung injury and acute respiratory distress syndrome (ARDS).

Ninety-one percent of the study participants had an abnormal chest x-ray. Among the 48 study participants that underwent CT scans, all had abnormal findings.

The chest x-rays and CT showed pulmonary infiltrates in both lungs, for example. Pulmonary infiltrates are substances that are denser than air that collect in the parts of the lungs that exchange oxygen, carbon dioxide and other gases. Pulmonary infiltrates are usually thick pus, blood or protein that collects as the result of pneumonia, tuberculosis and other lung diseases.

The CT scans also showed "ground-glass opacities" in both lungs. Radiologists use the term "ground-glass opacities" to describe a partial filling of the air spaces within the lungs. Ground glass opacities show up as hazy spots on CT scans. Patients who have malignant or benign (spreading or non-spreading) tumors or certain disease that cause inflammation or bleeding may show ground glass opacities on CT scans. Smokers and ex-smokers tend to have more ground glass opacities on CT scans than do people who have never smoked.

For more information on vaping-related illnesses, consult with your doctor. To learn more about using CT scans to detect and monitor these illnesses, talk with a radiologist. Anyone who has used e-cigarettes in the past and are now experiencing breathing problems should seek medical help right away.

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