Overview of Pathologic Findings of Vaping in the Context of an Autopsy Patient With Chronic Injury

Abstract

Context.— Electronic cigarettes are handheld devices that heat an inner liquid containing chemicals to be aerosolized and inhaled, and have become a popular alternative to conventional cigarettes. Their use, termed vaping, has been linked to severe injury, with 2711 cases of associated lung injury and 60 deaths reported to the Centers for Disease Control and Prevention at time of writing. Published case reports and series have emerged detailing clinical and imaging characteristics of vaping-induced lung injury. However, the pathologic characteristics of these induced injuries are still being established, particularly findings occurring over time. Objective.— To illustrate the autopsy findings of an older patient who died of vaping-induced injury after prolonged symptomology and to provide a review of the most recent literature regarding the basic science, epidemiology, clinical presentation, imaging characteristics, and pathology of vaping-induced lung injury. Data Sources.— Autopsy case and peer-reviewed literature. Conclusions.— Vaping-induced lung injury has emerged as a public health issue, and this case represents a rare opportunity to evaluate this issue at autopsy. Most commonly, the injury has been attributed to tetrahydrocannabinol product use as opposed to nicotine. This case demonstrates that as today's young and relatively healthy vapers grow older and develop the comorbidities that come with advanced age, there is serious risk of chronic lung damage from vaping that could result in death. Further observations and studies, particularly autopsy evidence, are clearly important to understand the possible outcomes.

Lesões Pulmonares Associadas ao Uso do Cigarro Eletrônico

“…Isso ocorre, mais detalhadamente, pela interação dos óleos com a membrana de surfactante pulmonar. 29,94,96 Ademais, os isômeros da vitamina E exercem efeitos regulatórios sobre a proteína quinase C a (PKCa) nas células endoteliais respiratórias, determinando o recrutamento de leucócitos, fase importante no desencadeamento de uma resposta exacerbada das vias aéreas e de inflamação pulmonar. Esse mecanismo associado a outros efeitos deletérios do vaping promovem modificações do epitélio respiratório (transição epitelial para mesenquimal) e do seu potencial carcinogênico.…”

“…Análise anatomopatológica foi realizada em 164 desses indivíduos, (material via broncoscopia) e achados mais frequentes: dano alveolar difuso, hemorragia 8 alveolar; pneumonia lipoide, proteinose alveolar e BOOP em alguns casos. 2,4,5,6,18,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38,39,40,41,42,43,44,45,46,47,48,49…”

Myocardial infarction injury is exacerbated by nicotine in vape aerosol exposure

“…Adverse impacts of vaping upon the cardiopulmonary system have been demonstrated in multiple experimental studies [3][4][5][6][7][8] that mirror clinical case reports from heavy vape users in several important ways. 3,[9][10][11][12][13][14][15][16][17][18][19] Notably, cardiovascular structure and function can deteriorate along with pathological changes in the lungs, including inflammation associated with exposure to vape juice flavorings and additives. The highly variable composition of vape aerosols coupled with lack of standardized vaping protocols have contributed to variability in reported outcomes.…”