Upper Lobe-Dominant Pulmonary Fibrosis Showing Deposits of Hard Metal Component in the Fibrotic Lesions

Yoshiko Kaneko; Norihiro Kikuchi; Yukio Ishii; Yoshinori Kawabata; Hiroshi Moriyama; Masaki Terada; Eiichi Suzuki; Masayoshi Kobayashi; Kouichi Watanabe; Nobuyuki Hizawa

doi:10.2169/internalmedicine.49.3801

CASE REPORTS

Upper Lobe-Dominant Pulmonary Fibrosis Showing Deposits of Hard Metal Component in the Fibrotic Lesions

Yoshiko Kaneko, Norihiro Kikuchi, Yukio Ishii, Yoshinori Kawabata, Hiroshi Moriyama, Masaki Terada, Eiichi Suzuki, Masayoshi Kobayashi, Kouichi Watanabe, Nobuyuki Hizawa

Author information

Yoshiko Kaneko
Department of Respiratory Medicine, University of Tsukuba
Norihiro Kikuchi
Department of Respiratory Medicine, University of Tsukuba
Yukio Ishii
Department of Respiratory Medicine, University of Tsukuba
Yoshinori Kawabata
Department of Pathology, Saitama Cardiovascular and Respiratory Center
Hiroshi Moriyama
Division of Respiratory Medicine, Niigata University Graduate School of Medical and Dental Sciences
Masaki Terada
Division of Respiratory Medicine, Niigata University Graduate School of Medical and Dental Sciences
Eiichi Suzuki
Department of General Medicine, Niigata University Medical and Dental Hospital
Masayoshi Kobayashi
EPMA Laboratory, Center of Instrumental Analysis, Niigata University
Kouichi Watanabe
EPMA Laboratory, Center of Instrumental Analysis, Niigata University
Nobuyuki Hizawa
Department of Respiratory Medicine, University of Tsukuba

Keywords: electron probe microanalysis, hard metal, pneumoconiosis, pulmonary fibrosis, upper lobe

JOURNAL OPEN ACCESS

2010 Volume 49 Issue 19 Pages 2143-2145

DOI https://doi.org/10.2169/internalmedicine.49.3801

Details

Abstract

We present a 54-year-old man employed in the field of hard metal manufacturing who complained of progressive dyspnea and weight loss. His chest radiograph showed bilateral fibrosis predominantly distributed in the upper lobes with bilateral pleural effusions, and a strong reduction in lung volume. Lung histopathology showed apical cap-like fibrosis but no giant cell interstitial pneumonia. Electron probe microanalysis detected tungsten deposits in the fibrotic region: we therefore considered this to be a case of hard metal disease. Hard metal disease should be considered as one possibility in the differential diagnosis of upper lobe-dominant pulmonary fibrosis.

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