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Is EVALI the new scapegoat for every abnormal chest imaging?

Published:February 25, 2020DOI:https://doi.org/10.1016/j.hrtlng.2020.02.005
      We read with great interest the enlightening article by Ansari-Gilani et al. published in your esteemed journal highlighting 3 alleged cases of E-cigarette use related lung diseases.
      • Ansari-Gilani K.
      • Petraszko A.M.
      • Teba C.V.
      • Reeves A.R.
      • Gupta A.
      • Gupta A.
      • et al.
      E-cigarette use related lung disease, review of clinical and imaging findings in 3 cases.
      However, upon reading the article carefully, it raises some concerns regarding the diagnosis. In the first case, the authors describe the extensive work up done for a patient who had chronic dyspnea, abnormal chest imaging 10 months prior to the index hospitalization and poorly defined granulomas on histopathological examination. Findings of granulomas and organizing pneumonia on histopathology are quite nonspecific. Recently published distinguished reviews explaining lung biopsy findings in vaping associated pulmonary illness favored interstitial thickening, diffuse alveolar damage and organizing pneumonia.
      • Mukhopadhyay S.
      • Mehrad M.
      • Dammert P.
      • Arrossi A.V.
      • Sarda R.
      • Brenner D.S.
      • et al.
      Lung biopsy findings in severe pulmonary illness associated with E-Cigarette use (Vaping): a report of eight cases.
      ,
      • Butt Y.M.
      • Smith M.L.
      • Tazelaar H.D.
      • Vaszar L.T.
      • Swanson K.L.
      • Cecchini M.J.
      • et al.
      Pathology of vaping-associated lung injury.
      Interestingly neither of the above papers reported “granulomas” as a finding in histopathological samples of patients with vaping associated lung injury. In their report, authors provided no information about the histopathological analysis for patient 2 and 3.
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