Bronchoalveolar Lavage (BAL) and Pathologic Assessment of Electronic Cigarette or Vaping Product Use-associated Lung Injury (EVALI): The EVALI-BAL Study, A Multicenter Cohort

Salem Harry-Hernandez, Jeffrey Thiboutot, Momen M. Wahidi, Coral X. Giovacchini, Jose De Cardenas, Catherine Meldrum, Jenna G. Los, Peter B. Illei, Samira Shojaee, Thomas Eissenberg, David Dibardino, Heather Giannini, Fabien Maldonado, Lance Roller, Lonny B. Yarmus, Christopher M. Kapp

Research output: Contribution to journalArticlepeer-review


Background: E-cigarette or vaping-use related acute lung injury (EVALI) is a spectrum of radiographic and histologic patterns consistent with acute to subacute lung injury. However, limited data exist characterizing bronchoalveolar lavage (BAL) findings. The goal of this study is to further define the pathologic findings from BAL and biopsy samples of subjects with EVALI across 7 institutions. Methods: A multicentered registry of patients admitted with EVALI who underwent flexible bronchoscopy with BAL+/-transbronchial biopsy from July 2019 to April 2021 was compiled for retrospective evaluation from 7 academic institutions throughout the United States. Radiographic and cytopathologic findings and frequencies were correlated with the substance vaped. Results: Data from 21 subjects (42.9% women) who were predominantly White (76.2%) with a median age of 25 years (range, 16 to 68) with EVALI were included in this study. Sixteen patients (76.2%) reported use of tetrahydrocannabinol; the remainder used nicotine. BAL was performed in 19 of the 21 subjects, and transbronchial lung biopsy was performed in 7 subjects. BAL findings revealed neutrophilic predominance (median, 59.5%, range, 3.1 to 98) in most cases. Ten BAL samples demonstrated pulmonary eosinophilia ranging from 0.2% to 49.1% with one subject suggesting a diagnosis of acute eosinophilic pneumonia associated with the use of e-cigarettes. Lipid-laden macrophages were noted in 10 of 15 reports (66.7%). Transbronchial biopsy most frequently demonstrated patterns of organizing pneumonia (57.1%). Conclusion: EVALI-associated BAL findings typically demonstrate a spectrum of nonspecific inflammatory changes, including neutrophilia, lipid-laden macrophages, and in some cases eosinophilia.

Original languageEnglish (US)
Pages (from-to)144-154
Number of pages11
JournalJournal of Bronchology and Interventional Pulmonology
Issue number2
StatePublished - Apr 22 2023


  • acute lung injury
  • bronchoalveolar lavage
  • e-cigarette
  • vaping

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine


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