BACKGROUND: In the United States in 2019, there was an outbreak of electronic cigarette, or vaping, product use-associated lung injury (EVALI). The manifestations of EVALI in adolescents are not well characterized. We describe the diagnosis, evaluation, and management of EVALI in adolescents hospitalized at a tertiary care, university-affiliated children's hospital. METHODS:A multidisciplinary committee developed an EVALI algorithm on the basis of guidelines from the Centers for Disease Control and Prevention. A retrospective chart review was conducted on patients diagnosed with EVALI. Descriptive analyses included sociodemographic characteristics, clinical presentation, laboratory and imaging results, pulmonary function testing, oxygen requirements, and clinic follow-up.RESULTS: Thirteen hospitalized adolescents were diagnosed with confirmed or probable EVALI. The majority were female (54%) with a mean age of 15.9 years. Sixty-nine percent of patients presented with respiratory symptoms, whereas gastrointestinal symptoms were prominent in 85% of patients. Vaping D-9-tetrahydrocannabinol was reported in 92% of patients, and vaping nicotine was reported in 62% of patients. All had bilateral ground-glass opacities on the chest computed tomography (CT) scan. Treatment with glucocorticoids led to clinical improvement in 11 of 12 patients. Treatment with glucocorticoids led to improvement in both forced expiratory volume in 1 second and forced vital capacity (P , .05). Four patients required home oxygen on the basis of 6-minute walk test results.CONCLUSIONS: Diagnosis of EVALI should be suspected on the basis of vaping history and clinical presentation. Glucocorticoid treatment led to an improvement in symptoms and lung function. The 6-minute walk test may help determine oxygen needs at discharge. WHAT'S KNOWN ON THIS SUBJECT:The prevalence of electronic cigarette use has more than doubled among eighth-to 12thgraders over the past 2 years. An outbreak of electronic cigarette, or vaping, product use-associated lung injury (EVALI) linked to vaping D-9-tetrahydrocannabinol occurred this fall, and adolescents were among those affected.WHAT THIS STUDY ADDS: Many teenagers affected by EVALI were female, were Hispanic, and had multiple psychosocial stressors. Lung function deficits due to EVALI appear reversible with steroids. Six-minute walk test results may help identify adolescents who would benefit from home oxygen.

E lectronic cigarettes (hereafter, e-cigarettes), also known as vapes, are battery-powered devices that aerosolize substances including flavors, tetrahydrocannabinol, and/ or nicotine for inhalation. First introduced in the United States around 2007, e-cigarettes have become the most commonly used tobacco product among the U.S. youth since 2014, and e-cigarette use has continued to increase substantially among adolescents in the past few years (1).Beginning in 2012, several case reports emerged raising the possibility of the link between e-cigarette use and lung injury (2-8). As of January 14, 2020, there have been 2668 reported cases with 60 confirmed deaths due to e-cigarette or vaping product use-associated lung injury (EVALI) in the U.S. territory, with patients under 18 years of age accounting for 15% of reported hospitalizations due to EVALI (9). The Centers for Disease Control and Prevention, or CDC, and the Food and Drug Administration, along with local and state departments and clinicians, have been actively researching the causes and pathophysiology of EVALI (9).Imaging plays a crucial role in the initial detection and evaluation of progression of EVALI. In the adult population, case reports and series have described the clinical and imaging findings of EVALI (1,10-13). To our knowledge, there is currently no published information regarding the chest radiographic and CT findings in pediatric patients with EVALI. This population is particularly vulnerable to e-cigarette use and its potentially life-threatening consequences. The purpose of our study was to evaluate chest radiographic and CT findings of EVALI in the pediatric population. Materials and MethodsInstitutional Review Board Approval This retrospective study of patients' chest radiographs, CT images, and medical records was approved by the investigators' institutional review board. Informed consent was waived due to the retrospective nature of this study.