A case of welder's lung with end-stage pulmonary fibrosis.

BACKGROUND: Welding, performed regularly by more than a million workers worldwide, is associated with exposures to irritative, fibrogenic and carcinogenic fumes and gases. METHODS AND RESULTS: We present the case of a welder who had worked under extremely poor hygiene conditions for nearly 20 years and had developed end-stage lung fibrosis, finally requiring lung transplantation. Detailed histopathology and scanning electron microscopy/energy dispersive X-ray spectroscopy (SEM/EDS) analyses of his lungs showed advanced interstitial fibrosis and dust deposits in the lungs and in peribronchial lymph nodes containing welding type bodies, Fe, Si (silica), Ti (titanium), SiAl (aluminum silicates), Fe with Cr (Steel), and Zr (Zirkonium). CONCLUSION: In the absence of a systemic disorder and the failure to meet the criteria for diagnosis of idiopathic pulmonary fibrosis (IPF), these findings suggest welder's lung fibrosis as the most likely diagnosis.

The impact of coal mine dust characteristics on pathways to respiratory harm: investigating the pneumoconiotic potency of coals.

Exposure to dust from the mining environment has historically resulted in epidemic levels of mortality and morbidity from pneumoconiotic diseases such as silicosis, coal workers' pneumoconiosis (CWP), and asbestosis. Studies have shown that CWP remains a critical issue at collieries across the globe, with some countries facing resurgent patterns of the disease and additional pathologies from long-term exposure. Compliance measures to reduce dust exposure rely primarily on the assumption that all "fine" particles are equally toxic irrespective of source or chemical composition. For several ore types, but more specifically coal, such an assumption is not practical due to the complex and highly variable nature of the material. Additionally, several studies have identified possible mechanisms of pathogenesis from the minerals and deleterious metals in coal. The purpose of this review was to provide a reassessment of the perspectives and strategies used to evaluate the pneumoconiotic potency of coal mine dust. Emphasis is on the physicochemical characteristics of coal mine dust such as mineralogy/mineral chemistry, particle shape, size, specific surface area, and free surface area-all of which have been highlighted as contributing factors to the expression of pro-inflammatory responses in the lung. The review also highlights the potential opportunity for more holistic risk characterisation strategies for coal mine dust, which consider the mineralogical and physicochemical aspects of the dust as variables relevant to the current proposed mechanisms for CWP pathogenesis.

Factors Affecting Development of Chronic Obstructive Pulmonary Disease in Pneumoconiosis Cases: A Cross-sectional Study Between 2017 and 2022 in Turkey.

OBJECTIVES: It was aimed to determine the factors affecting the development of chronic obstructive pulmonary disease (COPD) in pneumoconiosis cases. METHODS: Pneumoconiosis cases were divided into two groups as those with only pneumoconiosis and those with coexistence of pneumoconiosis and COPD. Demographic data, smoking habits, pulmonary function test, radiological findings, and occupational risk factors of the cases were compared. RESULTS: Chronic obstructive pulmonary disease was detected in 134 of 465 pneumoconiosis cases (28.8%) included in the study. It was determined that patients who developed COPD were statistically significantly older, had longer exposure duration, had lower forced expiratory volume in 1 second, forced vital capacity, and forced expiratory volume in 1 second/forced vital capacity values, and had more pulmonary symptoms. Chronic obstructive pulmonary disease development was more common in sandblasting workers, dental technicians, and miners than in other occupations. CONCLUSION: It has been shown that the risk of developing COPD is high in cases of pneumoconiosis, independent of smoking, especially in certain occupational groups.

Pathology and Mineralogy of the Pneumoconioses.

Pneumoconioses represent the spectrum of lung diseases caused by inhalation of respirable particulate matter small enough (typically <5-µm diameter) to reach the terminal airways and alveoli. Pneumoconioses primarily occur in occupational settings where workers perform demanding and skilled manual labor including mining, construction, stone fabrication, farming, plumbing, electronics manufacturing, shipyards, and more. Most pneumoconioses develop after decades of exposure, though shorter latencies can occur from more intense particulate matter exposures. In this review, we summarize the industrial exposures, pathologic findings, and mineralogic features of various well-characterized pneumoconioses including silicosis, silicatosis, mixed-dust pneumoconiosis, coal workers' pneumoconiosis, asbestosis, chronic beryllium disease, aluminosis, hard metal pneumoconiosis, and some less severe pneumoconioses. We also review a general framework for the diagnostic work-up of pneumoconioses for pulmonologists including obtaining a detailed occupational and environmental exposure history. Many pneumoconioses are irreversible and develop due to excessive cumulative respirable dust inhalation. Accurate diagnosis permits interventions to minimize ongoing fibrogenic dust exposure. A consistent occupational exposure history coupled with typical chest imaging findings is usually sufficient to make a clinical diagnosis without the need for tissue sampling. Lung biopsy may be required when exposure history, imaging, and testing are inconsistent, there are unusual or new exposures, or there is a need to obtain tissue for another indication such as suspected malignancy. Close collaboration and information-sharing with the pathologist prior to biopsy is of great importance for diagnosis, as many occupational lung diseases are missed due to insufficient communication. The pathologist has a broad range of analytic techniques including bright-field microscopy, polarized light microscopy, and special histologic stains that may confirm the diagnosis. Advanced techniques for particle characterization such as scanning electron microscopy/energy dispersive spectroscopy may be available in some centers.

A Descriptive Study of a Turkish Pneumoconiosis Case-Series.

BACKGROUND: The study aimed to examine the conditions and factors affecting pneumoconiosis cases to determine the dimensions of the pneumoconiosis problem. METHODS: This retrospective study was conducted in a tertiary research hospital between January 1, 2014, and December 31, 2021. Five hundred ninety-seven patients with pneumo- coniosis were included in the study. RESULTS: Large opacities were detected in 157 cases. When we compared cases with and without Pulmonary Massive Fibrosis (PMF), age and concomitant pulmonary disease were higher in PMF cases, which also showed lower FEV1, FVC, and FEV1/FVC. PMF was more frequent in subjects with long dust exposure duration (more than 20 years) and concomitant pulmonary diseases, particularly tuberculosis. Three occupations, sandblasters, dental technicians, and ceramic workers, showed the earliest onset of pneumoconiosis. CONCLUSIONS: The study presents pneumoconiosis data in a mixed and large population and contributes to the imple- mentation of evidence-based policies and interventions for countries like Turkey striving to cope with the problem of pneumoconiosis.

[Occupational health risk assessment of pneumoconiosis caused by dust exposure at 18 quarries in a given area of Hubei Province].

OBJECTIVE: To explore the occupational health risk level of pneumoconiosis caused by dust exposure in a given area of Hubei province. METHODS: From April 2021 to October 2021, 18 quarries were randomly selected in the areas where quarries were concentrated in Hubei Province to conduct on-site hygiene investigation and detection. A total of 384 workers were employed in the above quarries, and 293 workers were exposed to dust. The International Mining and Metals Commission's risk rating table method and occupational hazard risk index method were used to analyze the occupational health risk level from total and respirable dust views, respectively. Meanwhile, the square weighted Kappa test was performed to analyze the consistency between two risk assessment method. RESULTS: The median dust exposure rate of workers in the above18 enterprises was 73.22%, small, underground mining, and barite quarries had relatively higher dust exposure rates(all median were 100.00%). The medians of daily dust exposure time, personal protective equipment wearing rate, free silica content of dust, 8-hour time weighted average exposure concentration of total dust and respirable dust in each assessment indicator were 6-8 hours, 0%-24.00%, 1.69%-35.30%, 0.56-3.70 mg/m~3, and 0.33-1.20 mg/m~3, respectively. Occupational health risk assessment result showed the overall occupational health risk levels of quarries, as well as different production scales and mining method, were all low. Among different positions, wind driller and tunneling worker had high and medium occupational health risk, respectively, and the rest of the positions had low or very low risk. International Council on Mining and Mentals(ICMM) risk rating table method and the INDEX method consistency analyses showed that these two risk assessment method had strong consistency in terms of total dust(Kappa value was 0.65(95%CI 0.57-0.73)), and general consistency in term of respirable dust(Kappa value was 0.51(95%CI 0.39-0.62)). CONCLUSION: The overall occupational health risk level of pneumoconiosis caused by dust exposure in quarries was low, but risk levels were higher for wind driller and tunneling worker.

Postexposure progression of pneumoconiosis among former Appalachian coal miners.

BACKGROUND: The prevalence of pneumoconiosis among working United States underground coal miners has been increasing for the past two decades, with the highest rates of disease observed among miners in the central Appalachian states of Kentucky, Virginia, and West Virginia. Surveillance for this disease in the United States focuses on working coal miners, who continue to be occupationally exposed to dust. This study examines the radiographic evidence for postexposure progression of pneumoconiosis in a population of former coal miners no longer occupationally exposed to coal mine dust who were seen at a community radiology clinic in eastern Kentucky. METHODS: Data were obtained and analyzed from clinical records of former coal miners who had a clinic encounter during January 1, 2017-August 1, 2019, a recorded final year of employment, and ≥2 postemployment digital chest radiographs. Radiographs were classified according to the International Labour Office guidelines by at least two B Readers. A final summary pneumoconiosis severity score (range, 0-13), accounting for both small and large opacities, was assigned to each chest radiograph. Progression was defined as an increase in severity score between a miner's radiographs over time. RESULTS: Data for 130 former coal miners were analyzed. All miners were male and most (n = 114, 88%) had worked primarily in Kentucky. Information on race/ethnicity was not available. The most common job types were roof bolters (n = 51, 39%) and continuous miner operators (n = 46, 35%). Forty-one (31.5%) miners had evidence of radiographic disease progression after leaving the workforce, with a median of 3.6 years between first and latest postretirement radiograph. A total of 80 (62%) miners had evidence of pneumoconiosis on their latest radiograph, and two-thirds (n = 53) of these were classified as progressive massive fibrosis (PMF), the most severe form of the disease. CONCLUSIONS: Postexposure progression can occur in former coal miners, emphasizing the potential benefits of continued radiographic follow-up postemployment. In addition to participating in disease screening throughout their careers to detect pneumoconiosis early and facilitate intervention, radiographic follow-up of former coal miners can identify new or progressive radiographic findings even after workplace exposure to respirable coal mine dust ends. Identification of progressive pneumoconiosis in former miners has potential implications for clinical management and eligibility for disability compensation.

Chronic Pulmonary Aspergillosis Infection in Coal Workers Pneumoconiosis With Progressive Massive Fibrosis.

Pneumoconiosis is associated with coal dust particles depositing within the lung causing nodules coalesce to form progressive massive fibrosis (PMF). Cavitary lesions can develop in these PMF areas for concerns of tuberculosis and aspergillosis. We present a 59-year-old patient who had coal workers pneumoconiosis and PMF presenting with chronic dyspnea and hemoptysis with an upper cavitary lesion noted on chest imaging. He notes dyspnea with walking very short distances with associated productive cough. He admits to occasional wheezing, paroxysmal dyspnea, hemoptysis, and orthopnea but denies chest pain. He is an everyday smoker. His physical examination was only remarkable for bronchial breath sounds. On review of his prior imaging, he had a right upper lobe infiltrate as far back as 2012. As the years progressed, a new cavitary lesion developed in the PMF area which progressively got larger with a thick wall and no eccentric region noted inside the cavity. Tuberculosis test was negative. He underwent a transbronchial biopsy with methenamine silver stain which showed acute angle branching and septation suggestive of Aspergillus species. He was diagnosed with pulmonary aspergillosis and treated with voriconazole for 1 year. With pneumoconiosis and evidence confirming aspergillosis, the presence of a new lung infiltration with progression into a cavitary lesion leads to a diagnosis of chronic cavitary pulmonary aspergillosis (CCPA). With follow-up imaging showing extensive lung fibrosis, he had chronic fibrosing pulmonary aspergillosis (CFPA), a late-stage manifestation of CCPA.

Workers' Occupational Dust Exposure and Pulmonary Function Assessment: Cross-Sectional Study in China.

OBJECTIVE: This study aims to determine the occupational health status of workers exposed to dust and the risk factors of lung function decline, to provide a basis for formulating corresponding occupational disease-prevention strategies. METHODS: Data on 2045 workers exposed to dust, including their age, gender, exposure time, chest X-ray test results, and pulmonary function test results, were obtained from a key occupational disease monitoring project in Chongqing, China, in 2021. Chi-square tests and multifactorial logistic regression, and other methods, were used for statistical analysis. RESULTS: The prevalence of pneumoconiosis-like changes was 0.83% (17/2045), and the prevalence of abnormal forced expiratory volume in one second (FEV1), forced vital capacity (FVC), and FEV1/FVC was 4.25% (87/2045), 12.81% (262/2045), and 1.47% (30/2045), respectively. With increasing worker's age, the prevalence of abnormal pneumoconiosis-like changes (p = 0.0065), FEV1 (p = 0.0002), FVC (p < 0.0001), and FEV1/FVC (p = 0.0055) all increased. Factors such as age, exposure duration, enterprise size, and dust exposure concentration were associated with abnormal lung function. CONCLUSIONS: Workers exposed to occupational dust have a high rate of abnormal lung function. The government, enterprises, and individuals should pay attention to occupational dust exposure, and various effective measures should be actively taken to protect the life and health of workers.

Progressive massive fibrosis: An overview of the recent literature.

This review provides an overview of literature addressing progressive massive fibrosis (PMF) from September 2009 to the present. Advances are described in understanding its pathophysiology, epidemiology of the occurrence of PMF and related conditions, the impact of PMF on pulmonary function, advances in imaging of PMF, and factors affecting progression of pneumoconiosis in dust-exposed workers to PMF. Basic advances in understanding the etiology of PMF are impeded by the lack of a well-accepted animal model for human PMF. Recent studies evaluating lung tissue samples and epidemiologic investigations support an important role for the silica component of coal mine dust in causing coal workers' pneumoconiosis and PMF in contemporary coal miners in the United States and for silica in causing silicosis and PMF in artificial stone workers throughout the world. Development of PMF is associated with substantial decline in pulmonary function relative to no disease or small opacity pneumoconiosis. In recent reports, computed tomography has had greater sensitivity for detecting PMF than chest x-ray. Magnetic resonance imaging shows promise in differentiating between PMF and lung cancer. Although PMF develops in dust-exposed workers without previously identified small opacity pneumoconiosis, the presence of small opacity pneumoconiosis increases the risk for progression to PMF, as does heavier dust exposure. Recent literature does not document any effective new treatments for PMF and new therapies to prevent and treat PMF are an important need.

Trends in pneumoconiosis in Brazil, 1979-2019.

BACKGROUND: Pneumoconiosis is a lung disease related to exposure to dust in the workplace. The disease can induce irreversible damage to health, especially in lung tissue, and can cause progressive and permanent physical disabilities. AIMS: This study evaluated the temporal and spatial distribution of mortality rates (1979-2019) and hospital admissions (1995-2019) for pneumoconiosis in Brazil. METHODS: The outcomes were hospitalization and death due to pneumoconiosis: codes 500-506 according to the ICD-9 and J60-J66 according to the ICD-10. Data from this retrospective ecological study were collected from the Brazilian Ministry of Health database. RESULTS: Hospitalization for pneumoconiosis has decreased in all regions of Brazil. Hospitalizations occurred predominantly in men aged over 40 years. Death rates showed a temporal increase in all regions. Deaths occurred predominantly in men aged over 50 years. The highest hospitalization and death rates were in the states of the Midwest and South Regions. CONCLUSIONS: Pneumoconiosis is a preventable occupational disease, and ongoing occurrences of hospitalizations and deaths highlight the importance of inspecting industries and controlling occupational and environmental exposures.

Giant Cell Interstitial Pneumonia In Native, Transplanted And Re-Transplanted Lungs 8 Years Apart Without Known Hard Metal Exposure.

Pneumoconioses are a group of non-neoplastic pulmonary disorders caused by inhaled inorganic particles. Well-described pneumoconioses include asbestosis, silicosis, coal worker's pneumoconiosis, chronic beryllium disease, and hard metal lung disease. Giant cell interstitial pneumonia (GIP) is a distinctive and rare pneumoconiosis most frequently found in workers exposed to hard metals, primarily cobalt and tungsten carbide. The pathologic picture is considered virtually pathognomonic for hard metal lung disease, although this dogma has been questioned by a few reports of giant cell interstitial pneumonia in patients without apparent hard metal exposure. Giant cell interstitial pneumonia is even rarer in lung transplant recipients. Here, we present a patient without known hard metal exposure who was found to have persistent giant cell interstitial pneumonia in native, transplanted and re-transplanted lungs 8 years apart.

Effects of chemical composition on the lung cell response to coal particles: Implications for coal workers' pneumoconiosis.

BACKGROUND AND OBJECTIVE: Coal mine dust has a complex and heterogeneous chemical composition. It has been suggested that coal particle chemistry plays a critical role in determining the pathogenesis of coal workers' pneumoconiosis (CWP). In this study, we aimed to establish the association between the detrimental cellular response and the chemical composition of coal particles. METHODS: We sourced 19 real-world coal samples. Samples were crushed prior to use to minimize the impact of particle size on the response and to ensure the particles were respirable. Key chemical components and inorganic compounds were quantified in the coal samples. The cytotoxic, inflammatory and pro-fibrotic responses in epithelial cells, macrophages and fibroblasts were assessed following 24 h of exposure to coal particles. Principal component analysis (PCA) and stepwise regression were used to determine which chemical components of the coal particles were associated with the cell response. RESULTS: The cytotoxic, inflammatory and pro-fibrotic response varied considerably between coal samples. There was a high level of collinearity in the cell responses and between the chemical compounds within the coal samples. PCA identified three factors that explained 75% of the variance in the cell response. Stepwise multiple regression analysis identified K2 O (p <0.001) and Fe2 O3 (p = 0.011) as significant predictors of cytotoxicity and cytokine production, respectively. CONCLUSION: Our data clearly demonstrate that the detrimental cellular effects of exposure to coal mine dusts are highly dependent on particle chemistry. This has implications for understanding the pathogenesis of CWP.

Demonstrating the protective effect of a 70-year-old occupational exposure limit against pneumoconiosis caused by mica.

Workers involved in crushing, milling, screening, and bagging of mica scrap are at increased risk to develop pneumoconiosis, a progressive material overloading of the lung that can lead to fibrosis and, in the later stages, to dyspnea. Pneumoconiosis is only seen after 10-20 years of respiratory mica exposure, and it can have a latency period of up to 40 years-today's cases date back to exposures during the second half of the 20th century. An occupational lifetime exposure level of 3 mg/m3 respirable mica dust has been considered to present no risk of pneumoconiosis since 1951 when the American Conference of Governmental Industrial Hygienists (ACGIH) established a 20 million particles per cubic foot (mppcf) (3.5 mg/m3 respirable particles) exposure limit. As a result, numbers of unspecified and other pneumoconioses in the United States have steadily declined since the early 1970s. Data from the National Institute for Occupational Safety and Health documents a 91% decrease between 1972 and 2014 (i.e., the peak of documented cases and the latest reported data) for combined cases of aluminosis, berylliosis, stannosis, siderosis, and fibrosis from production and use of bauxite, graphite fibers, wollastonite, cadmium, Portland cement, emery, kaolin, antimony, and mica. Ample evidence indicates that the 70-year-old occupational lifetime exposure level of 3 mg/m3 respirable mica dust is protective of workers' health.

Inhalational lung diseases.

The term inhalational lung disease comprises a group of entities that develop secondary to the active aspiration of particles. Most are occupational lung diseases. Inhalational lung diseases are classified as occupational diseases (pneumoconiosis, chemical pneumonitis), hypersensitivity pneumonitis, and electronic-cigarette-associated lung diseases. The radiologic findings often consist of nonspecific interstitial patterns that can be difficult to interpret. Therefore, radiologists' experience and multidisciplinary teamwork are key to ensure correct evaluation. The role of the radiologist is fundamental in preventive measures as well as in diagnosis and management, having an important impact on patients' overall health. It is crucial to take into account patients' possible exposure to particles both at work and at home.

Clinical features and prognostic factors of systemic sclerosis in Guangxi, China: Retrospective, single-center study of long-term survival in 470 patients.

OBJECTIVE: Systemic sclerosis (SSc) is an autoimmune disease the prevalence of which varies among populations. We analyzed SSc patients from Guangxi to improve the clinical understanding of this disease. METHODS: Data of 470 SSc patients admitted to our institution from October 1,2012 to January 1,2019 were examined. The characteristics of these patients were analyzed using Kaplan-Meier survival analysis. Cox proportional-hazard regression was used to identify prognostic factors. RESULTS: The average age was 50.44 ± 12.31 years, 285 patients (60.6%) were women, 2.1% had pneumoconiosis, 58.2% had pulmonary interstitial disease (ILD), 18.7% had pulmonary hypertension (PH), and 3.6% had renal crisis. These patients had diffuse cutaneous systemic sclerosis (dcSSc, 70.2%) or limited cutaneous systemic sclerosis (29.7%), and PH and renal crisis were more common in the dcSSc group. Patients 50 years old or more had greater prevalences of ILD, PH, and musculoskeletal damage, greater positivity of laboratory biomarkers, and increased mortality (all P < .05). Seventy-four patients (15.7%) died. The non-survivors were older, had longer disease duration, had higher prevalences of ILD, restrictive ventilation dysfunction, PH, and renal crisis, and had higher levels of creatine kinase myocardial band (CK-MB), C-reactive protein, and immunoglobin A (all P < .05). Renal crisis, PH, and high CK-MB were independent risk factors for death. CONCLUSIONS: Pneumoconiosis was more common in SSc patients than the general population from this region. Our patients had a 10-year cumulative survival rate of 74.9%, higher than reported for patients from the US. Renal crisis, PH, and high CK-MB level were independent risk factors for death.

Early signs of pneumoconiosis in a dental technician in Italy: a case report.

BACKGROUND: Dental technicians are at high risk of pneumoconiosis, usually driven by inhalation of mixed dusts, including metals. An etiological diagnosis is not easy to be performed, particularly in advanced stages. CASE PRESENTATION: We describe the case of an early pneumoconiosis occurring in a 47-year-old dental technician who developed respiratory symptoms shortly after beginning work. She described the work environment as dusty and lacking relevant primary prevention tools. A chest CT showed multiple peripheral pseudonodular lesions in both lower lobes; bronchoalveolar lavage and bronchial aspirate evidenced numerous macrophages with reflective metal bodies included into the cytoplasm, that at scanning electron microscopy coupled to Energy Dispersive X-Ray Analysis resulted Zirconium and Aluminum, whereas Tungsten (W) was localized outside cells. End of shift urinary concentrations of W were substantially raised as compared to pre-shift (1.1 vs. 0.2 µg/L). CONCLUSIONS: We concluded for diagnosis of early work-related pneumoconiosis due to abnormal occupational exposure to metals. The case demonstrates the need also for dental professionals to comply with industrial hygiene standards and to be monitored by occupational health physicians.

Usual Interstitial Pneumonia Associated With Crystalline Silica Exposure in Pneumoconiosis: A Retrospective Cohort Study.

OBJECTIVE: We aimed to identify a relation between the level of silica exposure and the associated increase in the risk of radiologic usual interstitial pneumonia (UIP) pattern. METHODS: We selected data of 796 individuals with pneumoconiosis who had undergone a chest computed tomography (CT). We estimated the silica exposure by comparing their occupational history with the data silica dust exposure. RESULTS: Individuals employed as stonemasons demonstrated a 2.30-fold increase in the risk of developing UIP than coal mine workers (odds ratio [OR], 2.30; 95% confidence interval [CI], 1.04 to 5.07). The high silica exposure group was associated with a 2.23-fold increase in the risk of developing UIP than the low silica exposure group (OR, 2.23; 95% CI, 1.07 to 4.69). CONCLUSIONS: This study suggests that silica exposure is associated with an increased risk of developing UIP pattern, highlighting a dose-response relationship.

Pneumoconiosis with a Sarcoid-Like Reaction Other than Beryllium Exposure: A Case Report and Literature Review.

Background: Chronic beryllium disease (CBD) is a granulomatous disease that resembles sarcoidosis but is caused by beryllium. Clinical manifestations similar to those observed in CBD have occasionally been reported in exposure to dusts of other metals. However, reports describing the clinical, radiographic, and pathological findings in conditions other than beryllium-induced granulomatous lung diseases, and detailed information on mineralogical analyses of metal dusts, are limited. Case presentation: A 51-year-old Japanese man with rapidly progressing nodular shadows on chest radiography, and a 10-year occupation history of underground construction without beryllium exposure, was referred to our hospital. High-resolution computed tomography showed well-defined multiple centrilobular and perilobular nodules, and thickening of the intralobular septa in the middle and lower zones of both lungs. No extrathoracic manifestations were observed. Pathologically, the lung specimens showed 5-12 mm nodules with dust deposition and several non-necrotizing granulomas along the lymphatic routes. X-ray analytical electron microscopy of the same specimens revealed aluminum, iron, titanium, and silica deposition in the lung tissues. The patient stopped smoking and changed his occupation to avoid further dust exposure; the chest radiography shadows decreased 5 years later. Conclusion: The radiological appearances of CBD and sarcoidosis are similar, although mediastinal or hilar lymphadenopathy is less common in CBD and is usually seen in the presence of parenchymal opacities. Extrathoracic manifestations are also rare. Despite limited evidence, these findings are similar to those observed in pneumoconiosis with a sarcoid-like reaction due to exposure to dust other than of beryllium. Aluminum is frequently detected in patients with pneumoconiosis with a sarcoid-like reaction and is listed as an inorganic agent in the etiology of sarcoidosis. It was also detected in our patient and may have contributed to the etiology. Additionally, our case suggests that cessation of dust exposure may contribute to improvement under the aforementioned conditions.