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Hard Metal Lung Disease

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A Clinical Guide to Occupational and Environmental Lung Diseases

Part of the book series: Respiratory Medicine ((RM))

Abstract

Hard metal lung disease is an occupational interstitial lung disease that affects people exposed to dust of tungsten carbide, a hard metal. The culprit is likely the cobalt used as a binder when tungsten and carbon are heated and combined. The disease can occur in workers engaged in the manufacture, utilization, or maintenance of tools composed of hard metal. The frequency of hard metal lung disease is usually less than 1% in those workers. Hard metal lung disease is diagnosed on the basis of occupational history, high-resolution computed tomography (HRCT) appearance of interstitial lung disease, bronchoalveolar lavage, and/or surgical lung biopsy. HRCT findings of hard metal lung disease may consist of bilateral ground-glass opacities, areas of consolidation, irregular linear densities, extensive reticular infiltrates, and traction bronchiectasis. Diffuse centriolobular micronodular opacities are characteristic. The pathologic findings of hard metal lung disease are a pattern of giant cell interstitial pneumonia (GIP). Features of GIP are bronchiolocentric fibrosing interstitial pneumonia with bronchiolar and peribronchiolar fibrosis and increased macrophages in the airspaces associated with multinucleated giant cells. Multinucleated giant cells in bronchoalveolar lavage (BAL) or lung specimens are diagnostic for hard metal lung disease, but the absence of the cells does not exclude the possibility of the disease. Elemental analysis of BAL or lung specimens shows the presence of increased amount of tungsten and/or cobalt. Hard metal lung disease may improve after removal from exposure and often responds to corticosteroids therapy; however, fatally progressive cases have also been documented. Prevention through a comprehensive respiratory protection by exposure avoidance and use of personal protective equipment is needed.

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Acknowledgments

The authors would like to acknowledge Dr. Kouichi Watanabe and Mr. Masayoshi Kobayashi of EPMA Laboratory, Center of Instrumental Analysis, Niigata University, who contributed to elemental analysis of lung specimens. The authors also thank Dr. Eiichi Suzuki of the Department of General Medicine, Niigata University Medical and Dental Hospital for critical evaluation of the manuscript and Dr. Junichi Tanaka, Division of Respiratory Medicine, Graduate School of Medical and Dental Sciences, Niigata University for patient surveillance in Japan.

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Authors and Affiliations

  1. Division of Respiratory Medicine, Graduate School of Medical and Dental Sciences, Niigata University, 1-757, Asahimachi-dori, Chuo-ku, 951–8510, Niigata, Japan

    Toshinori Takada & Hiroshi Moriyama

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  1. Toshinori Takada
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  2. Hiroshi Moriyama
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Correspondence to Toshinori Takada .

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Editors and Affiliations

  1. Division of Pulmonary, Allergy and, Critical Care Medicine, Duke University Medical Center, 330 Trent Drive, Hanes House, Rm 105-B, Durham, 27705, North Carolina, USA

    Yuh-Chin T. Huang

  2. , Human Studies Facility, Environmental Public Health Division, 104 Mason Farm Road, Chapel Hill, 27711, North Carolina, USA

    Andrew J. Ghio

  3. Department of Medicine, Division of Environmental and, National Jewish Health, 1400 Jackson, Denver, 80206, Colorado, USA

    Lisa A. Maier

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Takada, T., Moriyama, H. (2012). Hard Metal Lung Disease. In: Huang, YC., Ghio, A., Maier, L. (eds) A Clinical Guide to Occupational and Environmental Lung Diseases. Respiratory Medicine. Humana Press, Totowa, NJ. https://doi.org/10.1007/978-1-62703-149-3_11

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  • DOI: https://doi.org/10.1007/978-1-62703-149-3_11

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  • Publisher Name: Humana Press, Totowa, NJ

  • Print ISBN: 978-1-62703-148-6

  • Online ISBN: 978-1-62703-149-3

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