CTICasesAcute Hypersensitivity Pneumonitis from Vaping Marijuana
Imaging findings
In a 30-year-old woman with about six weeks of cough, an early chest radiograph appears essentially normal, while a follow-up radiograph shows subtle diffuse haziness with faint, somewhat nodular opacities on the lateral view; a subsequent CT pulmonary angiogram performed for suspected pulmonary embolism instead shows diffuse, smudgy ground-glass opacity with innumerable centrilobular nodules throughout both lungs, producing a summation, busy-appearing lung.
Key takeaways
This markedly diffuse, non-airway-centered pattern is not typical of infection and instead strongly suggests an inhalational exposure; the patient, who had been vaping marijuana several nights a week, was treated empirically as an acute hypersensitivity pneumonitis-type reaction, possibly related to mold, plant material, or the vaping apparatus itself, after infectious workup was unrevealing, improving with steroids and cessation of antibiotics, reinforcing the teaching point that a truly diffuse, non-airway-centered process of this severity is essentially never a straightforward infection and should prompt questions about vaping, smoking, or other inhalational exposures, including the specific method of use.
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