Occupational hard metal lung disease: a case report / 中国职业医学

OBJECTIVE: To report the clinical manifestations,chest imaging,pathological changes,diagnosis and treatment on one case of hard metal lung disease( HMLD).METHODS: The occupational history,clinical manifestations,chest computed tomography and lung histopathological examinations of a case with pathologically confirmed HMLD were summarized.RESULTS: The patient began to cough and have dyspnea on exertion after 7 years of hard metal dust exposure of cobalt and tungsten, and pulmonary function test showed a restrictive ventilation dysfunction.Chest computed tomography showed bilateral areas of diffuse lesions,including ground-glass attenuation,areas of consolidation,diffuse small nodules, extensive reticular opacities and traction bronchiectasis.The lung histopathological changes include macrophage interstitial pneumonia,which is macrophages and a large number of multinucleated giant cells in the alveolar space.CONCLUSION: A clear history of hard metal dust exposure and the pathological examination of lung tissue are helpful for the diagnosis of HMLD.

A Case of Giant Cell Interstitial Pneumonia without History of Exposure to Hard Metal / 결핵

A 44 year old man was admitted complaining of exertional dyspnea. The patient denied denied any occupational history of hard metal exposure. Chest radiography showed an increased interstitial marking at the peripheral po rtion of both lower lung fields. The spirometric values were within the normal ranges. However, the diffusion capacity of the lungs was lower. In the bronchial lavage fluid, the characteristic multinucleated giant cells were noticed, and the macrophage compartment was 96% and the neutrophils were 4%. Highresolution CT scan revealed ground glass opacities with emphysematous lung changes at the peripheral portion of the whole lung. An open lung biopsy confirmed the presence of numerous multinucleated giant cells (Define GIF) with an associated interstitial fibrosis throughout the lung. The radiographic abnormalities and symptoms subsequently improved following treatment with oral corticosteroids.

A Case of Giant Cell Interstitial Pneumonia without History of Exposure to Hard Metal / 결핵

A 44 year old man was admitted complaining of exertional dyspnea. The patient denied denied any occupational history of hard metal exposure. Chest radiography showed an increased interstitial marking at the peripheral po rtion of both lower lung fields. The spirometric values were within the normal ranges. However, the diffusion capacity of the lungs was lower. In the bronchial lavage fluid, the characteristic multinucleated giant cells were noticed, and the macrophage compartment was 96% and the neutrophils were 4%. Highresolution CT scan revealed ground glass opacities with emphysematous lung changes at the peripheral portion of the whole lung. An open lung biopsy confirmed the presence of numerous multinucleated giant cells (Define GIF) with an associated interstitial fibrosis throughout the lung. The radiographic abnormalities and symptoms subsequently improved following treatment with oral corticosteroids.

A Case of Giant Cell Interstitial Pneumonia / 결핵

Giant cell interstitial pneumonia, a synonym of (for) hard metal pneumoconiosis, is a unique form of pulmonary fibrosis resulting from an exposure to hard metal dust. A case of biopsy-proved giant cell interstitial pneumonia in the absence of appropriate history of exposure to hard metal dust is reported. The patient presented with clinical features of chronic interstitial lung disease or idiopathic pulmonary fibrosis. He worked in a chemical laboratory at a fertilizer plant(,)where he had been exposed to various chemicals such as benzene and toluene. He denied having any other hobby in his house or job at work which may have exposed him hard metal dust(.) High-resolution CT scan revealed multi-lobar distribution of ground glass opacity with peripheral and basal lung predominance. The retrieved fluid of bronchoalveolar lavage contained asbestos fiber and showed neutrophil predominance. Surgical lung biopsy was performed for a definite diagnosis. Lung specimen showed alveolar infiltration of numerous multinucleated giant cells with mild interstitial fibrosis. Upon detailed examination of the lung tissue, one asbestos body was found. An analysis for mineral contents in lung tissue was performed. Compared to with the control specimen, the amount of cobalt and several hard metal components in the lung tissue of this patient was ten times higher. We speculated that the inconsistency between occupational history and the findings of pathologic and mineralogical analyses could be explained by the difference in individual immunologic reactivity to hard metal dust despite the relatively small amount of unrecognized environmental exposure (ED: It's hard to understand what this phrase is trying to say).