Two Cases of Hard Metal Lung Disease Diagnosed by the Detection of Metal in Transbronchial Lung Biopsy Specimens

• Published in: The Journal of the Japan Society for Respiratory Endoscopy Vol. 43; no. 4; pp. 431 - 436
• Main Authors: Sato, Ryota, Kawashima, Masahiro, Akagawa, Shinobu, Watanabe, Shizuka, Matsui, Hirotoshi, Tamura, Atsuhisa, Ohshima, Nobuharu, Kitani, Masashi
• Format: Journal Article
• Language: Japanese
• Published: The Japan Society for Respiratory Endoscopy 25.07.2021; 特定非営利活動法人 日本呼吸器内視鏡学会
• Subjects: Electron probe micro analyzer; Hard metal lung disease; Occupational lung disease; Transbronchial lung biopsy; 経気管支肺生検; 職業性肺疾患; 超硬合金肺; 電子線プローブマイクロアナライザー
• ISSN: 0287-2137; 2186-0149
• DOI: 10.18907/jjsre.43.4_431

Background. Hard metal lung is an occupational lung disease caused by exposure to particles of hard metal, especially cobalt. The diagnosis is made based on occupational exposure to hard metal and the identification of such components in lung specimens. Case 1. A 49-year-old man, who had worked in the hard-metal-processing industry without a dust protective mask, consulted us due to a cough, fever, and dyspnea. Computed tomography showed multiple bronchocentric nodules and cystic changes predominantly in the bilateral lower lungs. A transbronchial lung biopsy detected hard metal components, such as cobalt and tungsten, leading to the diagnosis of hard metal lung. Partial improvement was observed with avoidance of exposure and oral corticosteroid treatment. Case 2. A 27-year-old man had worked in the hard-metal-processing industry without a dust protective mask. He visited our hospital with cough and dyspnea. A transbronchial lung biopsy revealed hard metal components. Although he had been repeating spontaneous pneumothorax, since he retired from work, he had no more pneumothorax and his pulmonary function gradually improved. Conclusion. We experienced two cases in which an elemental analysis of transbronchial lung biopsy tissue identified hard metal components. In patients with a low lung function in whom a surgical lung biopsy is difficult, the identification of hard metal components by bronchoscopy is useful for the diagnosis.