A case of hard metal lung disease resembling a hypersensitive pneumonia in radiological images.

A 42-year-old man was admitted to our hospital because of exertional dyspnea. He had worked as a metal grinder for 3 years, but had quit his job 1 month before admission. Chest radiography and high-resolution computed tomography showed diffuse ground-glass opacities like hypersensitivity pneumonitis shadows. The results of high-energy dispersion X-ray microanalysis indicated that the patient had hard metal pneumoconiosis associated with tungsten. Since the histological changes distributed terminal to respiratory bronchiole and surrounding alveoli, and macrophages engulfed black granules within the alveoli, in absence of giant cells, we considered this case to be a type of hypersensitivity pneumonitis of hard metal lung.

Metals and health: a clinical toxicological perspective on tungsten and review of the literature.

Tungsten and tungsten compounds are considered toxicologically relatively safe. Concern regarding the potential health and environmental effects of depleted uranium and lead in military applications has lead many countries to explore the possibility of applying toxicologically safer metals. Heavy metal tungsten alloy-based munitions have been therefore introduced as a replacement in munitions and as kinetic energy penetrators. Although the toxicological profiles of all these metals are well known, their internalization as embedded shrapnel may be considered a new route for long-term exposure. Studies in experimental animals and cell culture indicate that pellets based on heavy metal tungsten alloy possess carcinogenic potential previously unseen for depleted uranium and/or lead. Other metals in the tungsten alloy such as nickel or cobalt may contribute to such a risk. Accordingly, the long-term tungsten-related health risk is reason for concern. This article reviews toxicological and clinical literature and provides new perspectives on tungsten and tungsten-based alloys.

A quantitative analysis of aerosols inside an armored vehicle perforated by a kinetic energy penetrator containing tungsten, nickel, and cobalt.

These tests were conducted to develop a database that could be used to assess risks to soldiers from exposure to aerosolized metallic particulates when the crew compartment of an Abrams tank is perforated by a kinetic energy penetrator. Quantitative data are reported for aerosols produced by kinetic energy penetrators containing tungsten, nickel, and cobalt. The following are addressed: (1) concentrations and rates of particle settling inside the vehicle, (2) particle size distribution, (3) inhalable and respirable particulates, (4) distribution of aerosol particles by mass, and (5) particle shapes. The scenario described in this report simulates a rare occurrence. The lessons learned, however, highlight a requirement for developing protocols for analyses of metals in body fluids and urine as soon as practical, and also for implementing targeted postdeployment medical surveillance programs that monitor both body burden for respired metals and pulmonary function.

Tungsten determination in biological fluids, hair and nails by plasma emission spectrometry in a case of severe acute intoxication in man.

A healthy 19-year-old recruit in a French artillery regiment drank 250 mL of a mixture of beer and wine that had rinsed in a hot 155-mm gun-barrel. Fifteen minutes later, he complained of nausea followed by seizures. He was comatose for 24 h, presenting signs of encephalopathy. A moderate renal failure was noted initially and worsened to an extensive tubular necrosis with anuria on the day after the incident. The first toxicological investigations only showed a 0.31 g/L blood ethanol. Then inductively-coupled plasma (ICP) emission-spectrometry revealed very high concentrations of tungsten in the "beverage" as well as in gastric content, blood and urine (1540 mg/L, 8 mg/L, 5 mg/L, and 101 mg/L, respectively). The nature of the metal was confirmed by ICP coupled to mass spectrometry. A simple and reliable ICP quantitative assay of tungsten in biological fluids, hair and nails was then developed. It showed high blood levels (> 0.005 mg/L) until day 13 in spite of six hemodialyses, and in urine until D33. Tungsten was also incorporated in hair and nails. To the best of our knowledge, such an intoxication has never been reported before though this drinking seems to be traditional in the French Artillery. It has probably been favored by the unusually high volume of beverage absorbed and by the new alloy of the gun, containing tungsten. The clinical evolution was satisfactory over weeks and the patient was declared totally cured after five months.

Memory deficits in workers suffering from hard metal disease.

This study examined memory functioning on the Wechsler Memory Scale-Revised in a group of adult tungsten carbide workers with hard metal disease and a group of matched controls. The hard-metal-exposed group of workers showed memory deficits related to difficulties in attention and verbal memory, with an apparent sparing of visual-spatial memory. Implications of this finding for future research are discussed.

[Pulmonary pathology due to cobalt and hard metals]. / La pathologie pulmonaire due au cobalt et aux métaux durs.

For forty years, cases of interstitial pneumonia and bronchial asthma have been described in hard metal workers (i.e., alloys of tungsten carbide and cobalt). Recently we have reported comparable pulmonary lesions in workers in the diamond industry who were exposed to cobalt unassociated with tungsten carbide. The exposure came from the diamond cobalt discs used for polishing diamonds, which had as the hard element microdiamonds, cemented in an alloy of pure cobalt. The hard metals on the other hand consisted of cobalt and tungsten carbide. Forty-seven diamond cutters (i.e., nearly 1% of those exposed) presented with broncho-pulmonary pathology due to cobalt. Nineteen had a fibrosing alveolitis, sometimes documented by a pulmonary biopsy and more often by a broncho-alveolar lavage which revealed characteristic multinucleated giant cells. Thirteen had occupational asthma, often proved by specific inhalation provocation tests to cobalt or by lung function measurements at the place of work. Two patients had mixed forms and in thirteen a probable diagnosis was suggested. The pathogenesis of cobalt might be explained by cytotoxic action such as has been demonstrated in animal experiments. Either results suggest a sensitising or allergic action. Tungsten carbide does not produce pulmonary lesions but its association with cobalt intensifies the effects of the latter.

[Diffuse interstitial pneumopathy related to tungsten carbide, confirmed by bronchoalveolar lavage, and responding to corticotherapy]. / Pneumopathie interstitielle diffuse liée au carbure de tungstène confirmée par lavage broncho-alvéolaire, régressive sous corticothérapie.

The authors report a case of severe diffuse interstitial hard metal lung disease responding to corticosteroid therapy. They point out that the course of this disease may be regressive and emphasise that analysis of broncho-alveolar washings showed no abnormality in the differential cell count. Mineralogical study of the same material confirmed exposure.

Automated characterization of particles extracted from human lungs: three cases of tungsten carbide exposure.

An automated scanning electron microscope-energy dispersive x-ray analysis-image analysis system was used to characterize particles extracted from three human lung samples which had suspected occupationally-induced lung disease. The particles were isolated from the lung tissues by low temperature ashing and deposited on Nuclepore filters. Particles in randomly selected fields of view for each filter were automatically sized, analyzed for 32 elements, and classified according to their chemistry by the system. For each of the three lung specimens, large numbers of particles were found which indicated exposure to cemented tungsten carbide products. The particle analysis data was collected at a rate of 200 particles per hour which is considerably faster than the rate at which manual, in situ analyses can be performed.