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.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Davison AG, Haslam PL, Corrin B, et al. Interstitial lung disease and asthma in hard-metal workers: bronchoalveolar lavage, ultrastructural, and analytical findings and results of bronchial provocation tests. Thorax. 1983;38(2):119–28.
Anttila S, Sutinen S, Paananen M, et al. Hard metal lung disease: a clinical, histological, ultrastructural and X-ray microanalytical study. Eur J Respir Dis. 1986;69(2):83–94.
Ohori NP, Sciurba FC, Owens GR, Hodgson MJ, Yousem SA. Giant-cell interstitial pneumonia and hard-metal pneumoconiosis. A clinicopathologic study of four cases and review of the literature. Am J Surg Pathol. 1989;13(7):581–7.
Liebow AA. Definition and classification of interstitial pneumonias in human pathology. Prog Respir Res. 1975;1–33.
Abraham JL, Burnett BR, Hunt A. Development and use of a pneumoconiosis database of human pulmonary inorganic particulate burden in over 400 lungs. Scanning Microsc. 1991;5(1):95–104; discussion 105–8.
Sprince NL, Oliver LC, Eisen EA, Greene RE, Chamberlin RI. Cobalt exposure and lung disease in tungsten carbide production. A cross-sectional study of current workers. Am Rev Respir Dis. 1988;138(5):1220–6.
Sprince NL, Chamberlin RI, Hales CA, Weber AL, Kazemi H. Respiratory disease in tungsten carbide production workers. Chest. 1984;86(4):549–57.
Nemery B, Verbeken EK, Demedts M. Giant cell interstitial pneumonia (hard metal lung disease, cobalt lung). Semin Respir Crit Care Med. 2001;22(4):435–48.
Delahant AB. An experimental study of the effects of rare metals on animal lungs. AMA Arch Ind Health. 1955;12(2):116–20.
Harding HE. Notes on the toxicology of cobalt metal. Br J Ind Med. 1950;7(2):76–8.
Demedts M, Gheysens B, Nagels J, et al. Cobalt lung in diamond polishers. Am Rev Respir Dis. 1984;130(1):130–5.
Lahaye D, Demedts M, van den Oever R, Roosels D. Lung diseases among diamond polishers due to cobalt? Lancet. 1984;1(8369):156–7.
Migliori M, Mosconi G, Michetti G, et al. Hard metal disease: eight workers with interstitial lung fibrosis due to cobalt exposure. Sci Total Environ. 1994;150(1–3):187–96.
Moriyama H, Kobayashi M, Takada T, et al. Two-dimensional analysis of elements and mononuclear cells in hard metal lung disease. Am J Respir Crit Care Med. 2007;176(1):70–7.
Nemery B, Bast A, Behr J, et al. Interstitial lung disease induced by exogenous agents: factors governing susceptibility. Eur Respir J Suppl. 2001;32:30s–42.
Menon B, Sharma A, Kripalani J, Jain S. Giant cell interstitial pneumonia in a 60-year-old female without hard metal exposure. Respiration. 2006;73(6):833–5.
Kakugawa T, Mukae H, Nagata T, et al. Giant cell interstitial pneumonia in a 15-year-old boy. Intern Med. 2002;41(11):1007–12.
Cugell DW. The hard metal diseases. Clin Chest Med. 1992;13(2):269–79.
Seike M, Usuki J, Uematsu K, et al. Giant cell interstitial pneumonia in a metal grinder with an abnormally high level of serum CA19-9. Nihon Kyobu Shikkan Gakkai Zasshi. 1995; 33(8):894–9.
Okuno K, Kobayashi K, Kotani Y, Ohnishi H, Ohbayashi C, Nishimura Y. A case of hard metal lung disease resembling a hypersensitive pneumonia in radiological images. Intern Med. 2010;49(12):1185–9.
Wahbi ZK, Arnold AG, Taylor AJ. Hard metal lung disease and pneumothorax. Respir Med. 1997;91(2):103–5.
Ruokonen EL, Linnainmaa M, Seuri M, Juhakoski P, Soderstrom KO. A fatal case of hard-metal disease. Scand J Work Environ Health. 1996;22(1):62–5.
Fischer T, Rystedt I. Cobalt allergy in hard metal workers. Contact Dermatitis. 1983;9(2): 115–21.
Shirakawa T, Kusaka Y, Fujimura N, Kato M, Heki S, Morimoto K. Hard metal asthma: cross immunological and respiratory reactivity between cobalt and nickel? Thorax. 1990; 45(4):267–71.
Ichikawa Y, Kusaka Y, Goto S. Biological monitoring of cobalt exposure, based on cobalt concentrations in blood and urine. Int Arch Occup Environ Health. 1985;55(4):269–76.
Alexandersson R. Blood and urinary concentrations as estimators of cobalt exposure. Arch Environ Health. 1988;43(4):299–303.
Akira M. Uncommon pneumoconioses: CT and pathologic findings. Radiology. 1995; 197(2):403–9.
Choi JW, Lee KS, Chung MP, Han J, Chung MJ, Park JS. Giant cell interstitial pneumonia: high-resolution CT and pathologic findings in four adult patients. AJR Am J Roentgenol. 2005;184(1):268–72.
Forni A. Bronchoalveolar lavage in the diagnosis of hard metal disease. Sci Total Environ. 1994;150(1–3):69–76.
Michetti G, Mosconi G, Zanelli R, et al. Bronchoalveolar lavage and its role in diagnosing cobalt lung disease. Sci Total Environ. 1994;150(1–3):173–8.
Tabatowski K, Roggli VL, Fulkerson WJ, Langley RL, Benning T, Johnston WW. Giant cell interstitial pneumonia in a hard-metal worker. Cytologic, histologic and analytical electron microscopic investigation. Acta Cytol. 1988;32(2):240–6.
Johnson NF, Haslam PL, Dewar A, Newman-Taylor AJ, Turner-Warwick M. Identification of inorganic dust particles in bronchoalveolar lavage macrophages by energy dispersive x-ray microanalysis. Arch Environ Health. 1986;41(3):133–44.
Naqvi AH, Hunt A, Burnett BR, Abraham JL. Pathologic spectrum and lung dust burden in giant cell interstitial pneumonia (hard metal disease/cobalt pneumonitis): review of 100 cases. Arch Environ Occup Health. 2008;63(2):51–70.
Archibald RW, Weller RO, Meadow SR. Measles pneumonia and the nature of the inclusion-bearing giant cells: a light- and electron-microscope study. J Pathol. 1971;103(1):27–34.
Anon. Statement on sarcoidosis. Joint Statement of the American Thoracic Society (ATS), the European Respiratory Society (ERS) and the World Association of Sarcoidosis and Other Granulomatous Disorders (WASOG) adopted by the ATS Board of Directors and by the ERS Executive Committee, February 1999. Am J Respir Crit Care Med. 1999;160(2):736–55.
Abraham JL, Burnett BR. Quantitative analysis of inorganic particulate burden in situ in tissue sections. Scan Electron Microsc. 1983;(Pt 2):681–96.
Goldstein JI, Newbury DE, Echlin P, et al. Scanning electron microscopy and X-ray microanalysis. New York: Plenum; 1994. p. 499–501.
Watanabe K, Miyakawa O, Kobayashi M. New method for quantitative mapping of metallic elements in tissue sections by electron probe microanalyser with wavelength dispersive spectrometers. J Electron Microsc (Tokyo). 2001;50(1):77–82.
Churg A, Wood P. Observations on the distribution of asbestos fibers in human lungs. Environ Res. 1983;31(2):374–80.
Gibbs AR, Pooley FD. Analysis and interpretation of inorganic mineral particles in “lung” tissues. Thorax. 1996;51(3):327–34.
Blanc PD. Is giant cell interstitial pneumonitis synonymous with hard metal lung disease? Am J Respir Crit Care Med. 2007;176(8):834; author reply 834–5.
Nemery B, Nagels J, Verbeken E, Dinsdale D, Demedts M. Rapidly fatal progression of cobalt lung in a diamond polisher. Am Rev Respir Dis. 1990;141(5 Pt 1):1373–8.
Sjogren I, Hillerdal G, Andersson A, Zetterstrom O. Hard metal lung disease: importance of cobalt in coolants. Thorax. 1980;35(9):653–9.
Cugell DW, Morgan WK, Perkins DG, Rubin A. The respiratory effects of cobalt. Arch Intern Med. 1990;150(1):177–83.
Balmes JR. Respiratory effects of hard-metal dust exposure. Occup Med. 1987;2(2):327–44.
Ratto D, Balmes J, Boylen T, Sharma OP. Pregnancy in a woman with severe pulmonary fibrosis secondary to hard metal disease. Chest. 1988;93(3):663–5.
Frost AE, Keller CA, Brown RW, et al. Giant cell interstitial pneumonitis. Disease recurrence in the transplanted lung. Am Rev Respir Dis. 1993;148(5):1401–4.
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.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2012 Springer Science+Business Media New York
About this chapter
Cite this chapter
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
Download citation
DOI: https://doi.org/10.1007/978-1-62703-149-3_11
Published:
Publisher Name: Humana Press, Totowa, NJ
Print ISBN: 978-1-62703-148-6
Online ISBN: 978-1-62703-149-3
eBook Packages: MedicineMedicine (R0)