Vape-Associated Pulmonary Injury (VAPI) Presenting With a "Miliary" Pattern on Imaging.

Area of Science:

• Pulmonology
• Radiology
• Toxicology

Background:

• Electronic (E)-cigarette use, or vaping, is linked to pulmonary injury.
• Vaping-associated pulmonary injury (VAPI) presents with diverse symptoms and imaging findings.
• Typical radiographic findings include bilateral, basilar ground-glass opacities and consolidation.

Observation:

• A previously healthy 34-year-old male presented with malaise, cough, and shortness of breath.
• Chest CT revealed diffuse nodules in a miliary pattern, an atypical finding for VAPI.
• The patient reported a six-month history of tetrahydrocannabinol (THC) vape use.

Findings:

• Bronchoscopy confirmed findings consistent with VAPI.
• This is the first reported case of VAPI presenting with a miliary pattern of infiltrates and nodules.
• The miliary pattern initially raised suspicion for other conditions like tuberculosis.

Implications:

• Vape-associated pulmonary injury (VAPI) should be considered in patients with miliary or diffuse micronodular patterns on imaging.
• Recognizing atypical presentations of VAPI is crucial for accurate diagnosis and timely treatment.
• This case underscores the potential for severe pulmonary complications from vaping, including those mimicking infectious diseases.