Use of an E-Cigarette (Vaping) or Dabbing in 90 Days Before the Onset of Symptoms
Pulmonary Infiltrate (Opacities on Chest X-Ray or Ground-Glass Opacities on Chest CT Scan)
Absence of Pulmonary Infection on Initial Evaluation
The Minimum Criteria Include Negative Respiratory Viral Panel and Influenza PCR or Rapid Test (if Local Epidemiology Supports Testing)
All Other Clinically Indicated Testing for Respiratory Infections (Urine Antigen Testing for Streptococcus Pneumoniae/Legionella, Sputum Culture if Productive Cough, Bronchoalveolar Lavage Culture if Done, Blood Culture, and Presence of HIV-Related Opportunistic Respiratory Infections if Appropriate) Must Be Negative
No Evidence in Medical Record of Alternative Plausible Diagnoses (Cardiac, Rheumatologic, or Neoplastic Disease)
Probable Case (Requires All of the Following)
Use of an E-Cigarette (Vaping) or Dabbing in 90 Days Before the Onset of Symptoms
Pulmonary Infiltrate (Opacities on Chest X-Ray or Ground-Glass Opacities on Chest CT Scan)
Infection Identified by Means of Culture or PCR, But the Clinical Team Caring for the Patient Believes That This is Not the Sole Cause of the Underlying Respiratory Disease Process
or as the Minimum Criteria, to Rule Out Pulmonary Infection Not Met (Testing Not Performed) and Clinical Team Caring for the Patient Believes That This is Not the Sole Cause of the Underlying Respiratory Disease Process
No Evidence in Medical Record of Alternative Plausible Diagnoses (Cardiac, Rheumatologic, or Neoplastic Disease)
Time Course
Median Duration of Symptoms Prior to Clinical Presentation: 6 days (range: 0-155 days) (NEJM, 2020) [MEDLINE]
Cardiovascular Manifestations
Sinus Tachycardia
Sinus Tachycardia (Heart Rate >100) Occurs in 63% of Cases (NEJM, 2020) [MEDLINE]
Gastrointestinal Manifestations
General Comments
At Least One Gastrointestinal Manifestation is Present in 77% of Cases (NEJM, 2020) [MEDLINE]
Ground-Glass Infiltrates and Consolidative Infiltrates in Dependent Portions of the lungs
Note: While Areas of Fat Attenuation (<-30 Hounsfield Units) are Generally a Characteristic Feature of Lipoid Pneumonia, Areas of Fat Attenuation are Typically Absent in EVALI Even When Bronchoalveolar Lavage (BAL) Fluid Has a High Number of Lipid-Laden Macrophages (NEJM, 2019) [MEDLINE]
Case report of electronic cigarettes possibly associated with eosinophilic pneumonitis in a previously healthy active-duty sailor. J Emerg Med. 2014;47(1):15 [MEDLINE]
A Cancer That Went Up in Smoke: Pulmonary Reaction to e-Cigarettes Imitating Metastatic Cancer. Chest. 2016;149(3):e65 [MEDLINE]
Hypersensitivity Pneumonitis and Acute Respiratory Distress Syndrome From E-Cigarette Use. Pediatrics 2018;141(6):e20163927 [MEDLINE]
Pulmonary lipid-laden macrophages and vaping. N Engl J Med 2019;381:1488–9. https://doi. org/10.1056/NEJMc1912038 [MEDLINE]
Characteristics of a Multistate Outbreak of Lung Injury Associated with E-cigarette Use, or Vaping – United States, 2019. MMWR Morb Mortal Wkly Rep. 2019;68(39):860 [MEDLINE]
E-cigarette product use, or vaping, among persons with associated lung injury—Illinois and Wisconsin, April–September 2019. MMWR Morb Mortal Wkly Rep 2019;68:865–9 [LINK]
Vaping-associated Acute Lung Injury: A Case Series. Am J Respir Crit Care Med. 2019;200(11):1430 [MEDLINE]
Clinical presentation, treatment, and short-term outcomes of lung injury associated with e-cigarettes or vaping: a prospective observational cohort study. Lancet. 2019;394(10214):2073 [MEDLINE]
E-cigarette, or vaping, product use associated lung injury (EVALI): case series and diagnostic approach. Lancet Respir Med. 2019;7(12):1017 [MEDLINE]
Imaging of Vaping-Associated Lung Disease. N Engl J Med. 2019;381(15):1486 [MEDLINE]
Pathology of Vaping-Associated Lung Injury. N Engl J Med. 2019;381(18):1780 [MEDLINE]
Clinical, Bronchoscopic, and Imaging Findings of e-Cigarette, or Vaping, Product Use-Associated Lung Injury Among Patients Treated at an Academic Medical Center. JAMA Netw Open. 2020;3(11):e2019176 [MEDLINE]
Severe Lung Injury Associated With Use of e-Cigarette, or Vaping, Products-California, 2019. JAMA Intern Med. 2020;180(6):861 [MEDLINE]
Update: Characteristics of a Nationwide Outbreak of E-cigarette, or Vaping, Product Use–Associated Lung Injury — United States, August 2019–January 2020. Weekly / January 24, 2020 / 69(3);90–94 [LINK]
Radiologic, Pathologic, Clinical, and Physiologic Findings of Electronic Cigarette or Vaping Product Use–associated Lung Injury (EVALI): Evolving Knowledge and Remaining Questions. Radiology 2020; 294:491–505 [MEDLINE]
Vitamin E Acetate in Bronchoalveolar-Lavage Fluid Associated with EVALI. N Engl J Med 2020;382:697-705 [MEDLINE]
Outbreak of Lung Injury Associated with the Use of E-Cigarette, or Vaping, Products. CDC. Updated February 25, 2020 [LINK]
Pulmonary Illness Related to E-Cigarette Use in Illinois and Wisconsin – Final Report. N Engl J Med. 2020;382(10):903 [MEDLINE]
Imaging Findings of Vaping-Associated Lung Injury. AJR Am J Roentgenol. 2020;214(3):498 [MEDLINE]
Diffuse alveolar haemorrhage secondary to e-cigarette “vaping” associated lung injury (EVALI) in a young European consumer. Eur Respir J. 2020;56(1) [MEDLINE]
More on the Pathology of Vaping-Associated Lung Injury. Reply. N Engl J Med. 2020;382(4):388 [MEDLINE]
Pathological findings in suspected cases of e-cigarette, or vaping, product use-associated lung injury (EVALI): a case series. Lancet Respir Med. 2020;8(12):1219 [MEDLINE]
Characterizing e-cigarette vaping-associated lung injury in the pediatric intensive care unit. Pediatr Pulmonol. 2021;56(1):162 [MEDLINE]
