CTICasesEVALI (vaping-associated lung injury) presenting as organizing pneumonia and DAD
Imaging findings
CT scan shows patchy ground-glass opacities with subpleural sparing. Over two months, the process rapidly progressed to a diffuse alveolar damage (DAD) pattern, which cleared dramatically after starting corticosteroids, followed by a late complication of aspiration pneumonia. BAL cytology showed massive amounts of intracellular and extracellular lipid on oil red O staining.
Key takeaways
E-cigarette or Vaping Product Use-Associated Lung Injury (EVALI) frequently manifests as an organizing pneumonia or DAD pattern with subpleural sparing. It is highly steroid-responsive, but patients may experience recurrences if steroids are tapered too quickly, and positive oil red O stains of BAL fluid support the diagnosis by demonstrating abundant lipid-laden macrophages.
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