Vaping-associated acute respiratory distress syndrome

Vaping-associated lung injury via the use of electronic nicotine delivery systems (ENDS) is currently being evaluated as a potential source of pulmonary injury with uncertain etiology as the use of tetrahydrocannabinol (THC) is increasing throughout the USA. ENDS are marketed to be unlike traditional cigarette smoking in that they are purported to contain only propylene glycol, vegetable glycerine, nicotine, and flavorants compared with the > 60 carcinogenic ingredients in cigarettes. The New England Journal of Medicine (NEJM) currently reports four imaging patterns correlated with vaping-attributed pathology including acute eosinophilic pneumonia, diffuse alveolar damage, organizing pneumonia, and lipoid pneumonia. The incidence and extent of lung disease in otherwise young healthy patients with a history of vaping has not however been definitively recognized within the field of radiology. We present a case of vaping-associated acute respiratory distress syndrome (ARDS) in a young patient with no additional past medical history. The immediate radiologic recognition of vaping as a risk factor for ARDS in the emergency setting is pivotal so that appropriate medical management and respiratory support can be initiated without delay.