A case series describing common radiographic and pathologic patterns of hard metal pneumoconiosis

J. Chiarchiaro; L.R. Tomsic; S. Strock; K.L. Veraldi; M. Nouraie; J. Sellares; K.O. Lindell; L.A. Ortiz; F.C. Sciurba; R.F. Kucera; S.A. Yousem; C.R. Fuhrman; D.J. Kass; K.F. Gibson

Respiratory Medicine Case Reports (Jan 2018)

A case series describing common radiographic and pathologic patterns of hard metal pneumoconiosis

J. Chiarchiaro,
L.R. Tomsic,
S. Strock,
K.L. Veraldi,
M. Nouraie,
J. Sellares,
K.O. Lindell,
L.A. Ortiz,
F.C. Sciurba,
R.F. Kucera,
S.A. Yousem,
C.R. Fuhrman,
D.J. Kass,
K.F. Gibson

Affiliations

J. Chiarchiaro: Division of Pulmonary Allergy and Critical Care, University of Pittsburgh School of Medicine, Pittsburgh PA, USA; The Dorothy P. and Richard P. Simmons Center for Interstitial Lung Disease, University of Pittsburgh School of Medicine, Pittsburgh PA, USA; Corresponding author. 628NW MUH 3459 Fifth Ave, Pittsburgh PA, 15213, USA.
L.R. Tomsic: Division of Pulmonary Allergy and Critical Care, University of Pittsburgh School of Medicine, Pittsburgh PA, USA; The Dorothy P. and Richard P. Simmons Center for Interstitial Lung Disease, University of Pittsburgh School of Medicine, Pittsburgh PA, USA
S. Strock: Division of Pulmonary Allergy and Critical Care, University of Pittsburgh School of Medicine, Pittsburgh PA, USA; The Dorothy P. and Richard P. Simmons Center for Interstitial Lung Disease, University of Pittsburgh School of Medicine, Pittsburgh PA, USA
K.L. Veraldi: Division of Pulmonary Allergy and Critical Care, University of Pittsburgh School of Medicine, Pittsburgh PA, USA; The Dorothy P. and Richard P. Simmons Center for Interstitial Lung Disease, University of Pittsburgh School of Medicine, Pittsburgh PA, USA
M. Nouraie: Division of Pulmonary Allergy and Critical Care, University of Pittsburgh School of Medicine, Pittsburgh PA, USA; The Dorothy P. and Richard P. Simmons Center for Interstitial Lung Disease, University of Pittsburgh School of Medicine, Pittsburgh PA, USA
J. Sellares: Division of Pulmonary Allergy and Critical Care, University of Pittsburgh School of Medicine, Pittsburgh PA, USA; The Dorothy P. and Richard P. Simmons Center for Interstitial Lung Disease, University of Pittsburgh School of Medicine, Pittsburgh PA, USA; Interstitial Lung Disease Program, Servei de Pneumologia, Hospital Clinic, IDIBAPS, Universitat de Barcelona, Barcelona, Spain
K.O. Lindell: Division of Pulmonary Allergy and Critical Care, University of Pittsburgh School of Medicine, Pittsburgh PA, USA; The Dorothy P. and Richard P. Simmons Center for Interstitial Lung Disease, University of Pittsburgh School of Medicine, Pittsburgh PA, USA
L.A. Ortiz: Division of Occupational Medicine, University of Pittsburgh School of Medicine, Pittsburgh PA, USA
F.C. Sciurba: Division of Pulmonary Allergy and Critical Care, University of Pittsburgh School of Medicine, Pittsburgh PA, USA
R.F. Kucera: Excela Westmoreland Hospital, Greensburg PA, USA
S.A. Yousem: Department of Pathology, University of Pittsburgh School of Medicine, Pittsburgh PA, USA
C.R. Fuhrman: Department of Radiology, University of Pittsburgh School of Medicine, Pittsburgh PA, USA
D.J. Kass: Division of Pulmonary Allergy and Critical Care, University of Pittsburgh School of Medicine, Pittsburgh PA, USA; The Dorothy P. and Richard P. Simmons Center for Interstitial Lung Disease, University of Pittsburgh School of Medicine, Pittsburgh PA, USA
K.F. Gibson: Division of Pulmonary Allergy and Critical Care, University of Pittsburgh School of Medicine, Pittsburgh PA, USA; The Dorothy P. and Richard P. Simmons Center for Interstitial Lung Disease, University of Pittsburgh School of Medicine, Pittsburgh PA, USA

Journal volume & issue: Vol. 25
pp. 124 – 128

Abstract

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Introduction: Hard metal pneumoconiosis is a rare but serious disease of the lungs associated with inhalational exposure to tungsten or cobalt dust. Little is known about the radiologic and pathologic characteristics of this disease and the efficacy of treating with immunosuppression. Objective: We describe the largest cohort of patients with hard metal pneumoconiosis in the literature, including radiographic and pathologic patterns as well as treatment options. Methods: We retrospectively identified patients from the University of Pittsburgh pathology registry between the years of 1985 and 2016. Experts in chest radiology and pulmonary pathology reviewed the cases for radiologic and pathologic patterns. Results: We identified 23 patients with a pathologic pattern of hard metal pneumoconiosis. The most common radiographic findings were ground glass opacities (93%) and small nodules (64%). Of 20 surgical biopsies, 17 (85%) showed features of giant cell interstitial pneumonia. Most patients received systemic corticosteroids and/or steroid-sparing immunosuppression. Conclusions: Hard metal pneumoconiosis is characterized predominately by radiographic ground glass opacities and giant cell interstitial pneumonia on histopathology. Systemic corticosteroids and steroid-sparing immunosuppression are common treatment options. Keywords: Lung diseases, Interstitial, Hard metal pneumoconiosis, Giant cell interstitial pneumonia

Published in Respiratory Medicine Case Reports

ISSN: 2213-0071 (Online)
Publisher: Elsevier
Country of publisher: Netherlands
LCC subjects: Medicine: Internal medicine: Specialties of internal medicine: Diseases of the respiratory system
Website: http://www.journals.elsevier.com/respiratory-medicine-case-reports/

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