From the Pediatric Radiology Division, Department of Radiology (M.A., J.F., J.K.K., C.M.P.) and the Pediatric Respiratory Medicine Division, Department of Pediatrics (D.R., A.D.), UT Southwestern Medical Center and Children's Medical Center, 5323 Harry Hines Blvd, CMC F1.02, Dallas, TX 75390; and Department of Radiology, Boston Children's Hospital and Harvard Medical School, Boston, Mass (A.J.W., E.Y.L.).
Radiology. 2020 May;295(2):430-438. doi: 10.1148/radiol.2020192778. Epub 2020 Mar 3.
Background Electronic cigarette or vaping product use-associated lung injury (EVALI) is a serious public health concern with substantial morbidity and mortality, particularly in young individuals. Purpose To evaluate chest radiographic and chest CT findings of EVALI in the pediatric population. Materials and Methods This was a retrospective study of children who presented to a tertiary pediatric hospital from December 2018 to December 2019. Patients fulfilled the Centers for Disease Control and Prevention criteria for EVALI and had chest radiographs and CT images available at initial presentation. Two pediatric radiologists independently reviewed imaging for pattern, distribution, and extent of pulmonary abnormalities, as well as for extrapulmonary abnormalities. Clinical information, management, and outcomes were reviewed. Interobserver agreement was measured with Cohen κ coefficient. Results Seven male patients (50%) and seven female patients (50%) (mean age, 16 years; range, 13-18 years) were evaluated. All patients underwent chest radiography and CT within 4 days of presentation (range, 0-4 days). Chest radiographic findings included ground-glass opacity in 14 of 14 (100%) and consolidation in eight of 14 (57%). CT findings included ground-glass opacity in 14 of 14 (100%), consolidation in nine of 14 (64%), and interlobular septal thickening in two of 14 (14%). At CT, subpleural sparing was seen in 11 of 14 (79%) and a reversed halo sign was seen in five of 14 (36%). Chest radiographic and CT abnormalities were predominately bilateral in 14 of 14 (100%) and symmetric in 13 of 14 (93%), with lower lobe predominance in seven of 14 (50%). Extent of abnormality was predominately diffuse at both chest radiography and CT. There was almost perfect interobserver agreement between two reviewers for detecting abnormalities on chest radiographs (κ = 0.99; 95% confidence interval: 0.97, 1.00) and CT (κ = 0.99; 95% confidence interval: 0.98, 1.00). Conclusion In pediatric patients, electronic cigarette or vaping product use-associated lung injury is characterized by bilateral symmetric ground-glass opacities, consolidation, and a lower lobe predominance at CT. © RSNA, 2020.
背景 电子烟或蒸气产品使用相关的肺损伤（EVALI）是一个严重的公共卫生问题，发病率和死亡率都很高，尤其是在年轻人中。目的 评估儿科人群中 EVALI 的胸部 X 线和胸部 CT 表现。材料与方法 这是一项回顾性研究，纳入了 2018 年 12 月至 2019 年 12 月期间在一家三级儿科医院就诊的患儿。患者符合疾病预防控制中心 EVALI 的标准，并且在初次就诊时具备胸部 X 线和 CT 图像。两名儿科放射科医生独立评估了影像学表现的模式、分布和程度，以及肺外异常。还回顾了临床信息、治疗和结局。使用 Cohen κ 系数测量了观察者间的一致性。结果 共评估了 7 名男性患者（50%）和 7 名女性患者（50%）（平均年龄 16 岁；范围，13-18 岁）。所有患者在就诊后 4 天内（范围，0-4 天）进行了胸部 X 线和 CT 检查。胸部 X 线摄影表现包括 14 例（100%）的磨玻璃影和 8 例（57%）的实变。CT 表现包括 14 例（100%）的磨玻璃影、9 例（64%）的实变和 2 例（14%）的小叶间隔增厚。在 CT 上，11 例（79%）可见胸膜下保留，5 例（36%）可见反转晕征。14 例（100%）胸部 X 线和 CT 异常主要为双侧对称，13 例（93%）为双侧对称，7 例（50%）以肺下叶为主。病变程度在胸部 X 线和 CT 上均主要为弥漫性。两名观察者在检测胸部 X 线和 CT 上的异常方面具有几乎完美的一致性（κ=0.99；95%置信区间：0.97，1.00）。结论 在儿科患者中，电子烟或蒸气产品使用相关的肺损伤在 CT 上表现为双侧对称的磨玻璃影、实变和下叶为主。
