CTICasesVaping-Induced Hard Metal Pneumoconiosis
Imaging findings
Chest CT in a 48-year-old female smoker who recently transitioned to vaping shows diffuse, bilateral ground-glass opacities and subtle peribronchovascular thickening without subpleural sparing or honeycombing, mimicking an NSIP or hypersensitivity pneumonitis pattern. Surgical lung biopsy demonstrates giant cell interstitial pneumonia (GIP). Mass spectroscopy of her vape pen elements shows the presence of tungsten.
Key takeaways
Giant cell interstitial pneumonia (GIP) is classically considered pathognomonic for hard metal/cobalt-tungsten exposure. Recently, vaping has emerged as a novel source of heavy metal inhalation, as the heating coils inside vape pens (often containing tungsten, nickel, or chromium) can leach metals into the aerosol. GIP should be considered in vapers presenting with unexplained fibrosing interstitial lung disease.
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