PMID: 7939613Jun 30, 1994Paper

The differential diagnosis of hard metal lung disease

The Science of the Total Environment
G RizzatoM Barberis


Hard metal lung disease is usually easy to diagnose, on the basis of occupational history, chest X-ray appearance of interstitial lung disease and, if necessary, by bronchoalveolar lavage (BAL). However, other interstitial lung diseases may affect patients with an occupational history of exposure to cobalt. In hard metal disease, the hylar lymphnodes may enlarge due to high draining of hard metals from the lung tissue via lymphatic vessels. Also, the presence of Giant Cells (even if Langhan's type) in the BAL fluid of sarcoid patients may be high. We present four patients with a history of exposure to hard metals and whose chest X-rays suggest sarcoidosis, stage II; in each, a pulmonary biopsy was necessary to confirm the diagnosis. Final diagnosis was sarcoidosis in one (showing typical granulomata in the lung tissue), and hard metal disease in three: two of these had foreign body-type granulomata in the lung tissue. Neutron activation analysis (NAA) study was carried out on these four patients using specimens of BAL fluid, blood, urine, toenails, pubic hair and sperm. In the light of available data, the concentration of elements may not be useful in differentiating between sarcoidosis and hard metal pneumoconiosis. However, N...Continue Reading


Jul 1, 1986·Chest·G RizzatoE Sabbioni
Oct 1, 1986·British Journal of Industrial Medicine·S RedlineJ L Abraham
Nov 1, 1971·Annals of Internal Medicine·E O Coates, J H Watson
May 1, 1968·Australasian Radiology·M Joseph
Jan 21, 1984·Lancet·D LahayeD Roosels
Sep 1, 1980·Thorax·I SjögrenO Zetterström

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Jun 30, 1994·The Science of the Total Environment·G Nordberg
Jun 30, 1994·The Science of the Total Environment·E SabbioniP Seghizzi
Oct 4, 2002·Journal of Thoracic Imaging·Michael B GotwayJohn R Balmes
Aug 10, 2000·Environmental Health Perspectives·P KelleherL S Newman
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