A global look at the vaping lung

Abstract

The use of vapers is a practice that is increasing and with it the appearance of new clinical
syndromes, such as the EVALI, or Lung injury associated with the use of electronic cigarettes or
vaping products, which has been the cause of numerous deaths since it was identified, being of
vital importance the understanding of its pathophysiology, clinical-radiological manifestations
as well as its histology for an adequate diagnostic approach; Taking into account that this entity
has an acute presentation, it is important that its diagnosis is based on an adequate anamnesis
in which it evidences the use of vapers, as well as in radiological methods such as tomography
and histopathological methods such as bronchoalveolar lavage fluid stains and/or lung biopsy.
Because there is no standard paraclinical diagnostic, it will be performed by exclusion. Multiple
studies have allowed hypotheses to be raised about the pathophysiology of this entity, in which
vitamin E acetate and tetrahydrocannabinol are presented as toxic present in a high percentage
of patients who develop EVALI, the linking of injury by oxidative stress, alteration at the level of
pulmonary surfactant, as well as the alteration in the function of immune system cells such as
macrophages and fibroblasts in the development of the disease.
The diagnostic images have allowed identifying in these patients certain radiological findings,
being the most frequent: the infiltrates in ground glass and the pulmonary consolidations, with
multifocal distribution, identifying patterns of acute lung injury; the pathology studies could
identify in the bronchoalveolar lavage fluid, macrophages with abundant lipid inclusions, as well
as multiple neutrophils, histology in lung biopsies showed acute lesion patterns, such as acute
fibrinous pneumonitis, diffuse alveolar damage, and organized pneumonia.
The present review made a description of the main hypotheses about the pathophysiology
of this entity, as well as the clinical, radiological and histopathological findings found at the
pulmonary level in patients with development of EVALI.