Whilst nearly 3,000 e-cigarette-related hospitalizations have been reported in North America, the long-term outcomes in these patients have not been described. We followed an 18-year-old male who survived acute critical illness and respiratory failure related to five-months of e-cigarette use. Chronic irreversible airflow obstruction and markedly abnormal Xe magnetic resonance imaging (MRI) ventilation heterogeneity was observed and persisted 8-months post-hospital discharge, despite improvement in quality-of-life and chest computed tomography findings. Lung clearance index and oscillometry measures were also highly abnormal at 8-months post-discharge. Although Xe MRI ventilation abnormalities were dominant in the lung apices and central lung regions, the pattern of ventilation defects was dissimilar to ventilation heterogeneity observed in patients with obstructive lung disease, such as asthma and COPD. Our findings underscore the long-term functional impacts of e-cigarette-related lung injury in survivors of critical illness; longitudinal evaluations may shed light on the pathophysiologic mechanisms that drive e-cigarette-related lung disease.Copyright © 2020. Published by Elsevier Inc.