30 September 2023

False: These CT images of lungs do not link vaping disease to COVID-19

Ground-glass opacity is a common manifestation of lung injury. It does not imply any link between COVID-19 and vaping disease.

A tweet posted on June 17 claims that vaping lung disease and COVID-19 have “completely identical,” “iconic” ground-glass opacity lesions with a series of computed tomography (CT) scan images.

The Chinese post, when translated to English, reads:

Fort Detrick should come clean.

June 28, 2019, the first e-cigarette pneumonia appeared in the U.S.;

September 6, 2019, a study published on Techspot (Picture 1. I downloaded and saved the PDF at that time. Is it still there?) analyzed CT scan images of lungs of four patients (Picture 2);

Picture 3 is the CT scan images from Wubei confirmed cases;

Picture 4 is a comparison. Completely identical, iconic ground-glass opacity lesions. You say this is a coincidence?

Please retweet.

The post has been retweeted over 80 times and gained more than 160 likes but the claim is false.

To begin with, the part in the CT images circled by the Twitter user is actually the heart, not the lungs.

An expert interviewed by Annie Lab said the scan images simply show the presence of ground-glass opacity, a typical manifestation of injured lungs. It doesn’t indicate any link between vaping disease and COVID-19.

Screenshot of the post.

The tweet in question says the first and second sets of CT images (Picture 1 and 2) were taken from an academic paper on vaping-related lung disease mentioned by Techspot, a technology news website.

The Techspot article said the vaping disease, which is commonly known as EVALI (e-cigarette or vaping product use associated lung injury), could have been caused by a specific chemical like vitamin E acetate or a mixture of chemicals.

Counterfeit or contaminated vape liquids and devices were also named as the possible causes being investigated by experts.

Figure 1 from the tweet of a Techspot article about EVALI


Figure 2 from the tweet (left) : A set of CT scan images first appeared in the New England Journal of Medicine (right)

The images were taken from an article titled “Imaging of Vaping-Associated Lung Disease” published in the New England Journal of Medicine on Sep. 6, 2019.

The third set of images (Picture 3), on the other hand, comes from a “diagnosis of novel coronavirus pneumonia” published in the Chinese Journal of Radiology by the Chinese Society of Radiology, Chinese Medical Association. According to the article, the CT images show the lungs of a COVID-19 patient.

Figure 3 from the tweet (left): A different set of CT scan images from Chinese Journal of Radiology showing lungs of a COVID-19 patient (right)

The Twitter user says the image set in Picture 4 compares the second and third sets of CT images and claims that the ground glass opacity seen in both images is identical, implying a link between the vaping disease and COVID-19.

Clinical virologist Siddharth Sridhar from the Department of Microbiology at the University of Hong Kong said in an email on June 28 that the encircled parts do not show lungs, but the hearts.

Image 4 from the tweet comparing Pictures 2 and 3; The heart was encircled in red by the author of the tweet, however, not lungs as claimed.

“The presence of ground glass lesions do not imply any link between COVID-19 and vaping-associated lung injury,” he wrote.

According to Sridhar, there is an array of causes for identical-looking ground-glass opacity.

“Ground glass changes are extremely non-specific and are a common manifestation of lung injury…,” he said.

Annie Lab found CT images of similar ground-glass opacity in the lungs of smokers in this 2019 study titled “Diffuse smoking-related lung diseases: insights from a radiologic-pathologic correlation.”

CT image (middle) shows ground-glass opacity in a heavy smoker with desquamative interstitial pneumonia (DIP).

Fort Detrick is a U.S. military biodefense center. An infectious disease lab at the center was closed for a few months in the summer of 2019. Chinese state media and the spokesperson from the Foreign Ministry called for international investigations of the lab in relation to COVID-19 and said the U.S. should be cooperative and transparent about Fort Detrick.