Diagnosis of EVALI

Q: All of the following are used to confirm or to designate probable diagnosis of E-cigarette or vaping product use-associated lung injury (EVALI) EXCEPT?

A) Use of an e-cigarette or related product in the last 3 months

B) Lung opacities on chest radiograph or CT

C) Exclusion of lung infection by objective diagnostic means

D) Clinical signs (Fever, Tachycardia, or Shortness of Breath)

E) Absence of a likely alternative diagnosis

Answer: D

The criteria to confirm EVALI require four components:

• History of E-Cigarette use by any modality in the last 90 days
• Lung opacities either on CXR ot CT scan
• Exclusion of lung infection via viral respiratory panel, COVID-19 test, urine antigen tests, blood cultures, sputum culture, bronchoalveolar lavage (BAL), and/or HIV-related opportunistic infections.
• Absence of an alternative diagnosis (eg, cardiac, neoplastic, rheumatologic)

If infection cannot be excluded with certainty, it should be labeled as "probable diagnosis of EVALI."

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References:

1. Layden JE, Ghinai I, Pray I, et al. Pulmonary Illness Related to E-Cigarette Use in Illinois and Wisconsin - Final Report. N Engl J Med 2020; 382:903.

2. Schier JG, Meiman JG, Layden J, et al. Severe Pulmonary Disease Associated with Electronic-Cigarette-Product Use - Interim Guidance. MMWR Morb Mortal Wkly Rep 2019; 68:787.

3. Tituana NY, Clavijo CG, Espinoza EF, Tituana VA. E-cigarette use-associated lung injury (EVALI). Pneumologie. 2024 Jan;78(1):58-69. doi: 10.1055/a-2161-0105. Epub 2023 Oct 19. PMID: 37857323; PMCID: PMC10791482.

4. Sund LJ, Dargan PI, Archer JRH, Wood DM. E-cigarette or vaping-associated lung injury (EVALI): a review of international case reports from outside the United States of America. Clin Toxicol (Phila). 2023 Feb;61(2):91-97. doi: 10.1080/15563650.2022.2160342. Epub 2023 Jan 13. PMID: 36636876.