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The inhalation of hard metal may produce various respiratory manifestations including upper respiratory tract irritation, asthma, hypersensitivity pneumonia (HP), and a particular form of interstitial lung disease. Co is the main cause of the adverse health outcomes in hard metal workers. A particular form of interstitial lung disease, called hard metal lung disease (HMLD) includes giant cell interstitial pneumonia (GIP) and pulmonary fibrosis. Clinical and radiologic features of GIP resemble those of HP. In patients with HMLD, pulmonary fibrosis showing usual interstitial pneumonia (UIP) pattern is found. It is unclear that GIP progresses to severe fibrosis showing UIP pattern if the exposure to hard metal is not stopped. Follow-up CT scans suggest that GIP dose not progress to fibrosis showing UIP pattern. GIP and hard metal induced pulmonary fibrosis may be two different representations resulting from exposure to hard metal. Under current diagnostic criteria, both GIP and pulmonary fibrosis with UIP pattern are included.Cobalt exposure can occur inhalation, ingestion, and dermal routes. There is knowledge regarding the importance of cobalt ions skin absorption in relation to absorption via the respiratory tract in cobalt exposure. Co ions skin absorption can be considered as the reason that cases of hard metal workers’ asthma and HMLD occur more often at the wet area than at the dry area.

Objectives. The purpose of this study was to retrospectively assess cystic changes in findings on follow-up CT scans of patients with fibrotic nonspecific interstitial pneumonia (NSIP). Methods. The initial and last high-resolution CT scans of 58 patients with pathologically proven fibrotic NSIP were evaluated retrospectively. The median follow-up periods were 48 months (range, 12–183 months). The pattern, extent, and distribution of abnormal CT findings were compared with findings in the same region on previous and subsequent CT scans with a focus on cystic lesions. Results. Cystic lesions in a cluster were shown in 16 patients (28%) with fibrotic NSIP on the last CT scans. Focal clustered cysts were found in 5 cases and diffuse clustered cysts were seen in 11 cases. Focal clustered cysts mimicked honeycombing seen in usual interstitial pneumonia (UIP). Diffuse cysts were uniform in size in 7 of the 11 cases. Traction bronchiectasis in a cluster was seen in 3 of the 7 cases. The clustered cystic changes on CT during the course of NSIP mainly consisted of traction bronchiectasis and bronchiolectasis. Conclusions. Long-standing NSIP did not form honeycombing. The clustered cysts in patients with fibrotic NSIP were mainly remodeling of bronchiectasis.

Background. Pulmonary sarcoidosis predominantly affects the upper lung zones but sometimes affects the lower lung zones. We hypothesised that patients with lower lung zone-dominant sarcoidosis had lower baseline forced vital capacity, progressive restrictive lung function decline, and higher long-term mortality. Methods. We retrospectively reviewed clinical data including the pulmonary function tests of 108 consecutive patients with pulmonary sarcoidosis pathologically confirmed by lung and/or mediastinal lymph node biopsy from 2004 to 2014 from our database. Results. Eleven patients (10.2%) with lower lung zone-dominant sarcoidosis were compared with 97 patients with nonlower lung zone-dominant sarcoidosis. The median age of the patients with lower dominance was significantly older (71 vs. 56, p=0.0005). The patient with lower dominance had a significantly lower baseline percent forced vital capacity (FVC) (96.0% vs. 103%, p=0.022). The annual change in FVC was −112 mL in those with lower dominance vs. 0 mL in nonlower dominance (p=0.0033). Fatal acute deterioration was observed in three patients (27%) in the lower dominant group. Overall survival in the lower dominant group was significantly worse. Conclusions. Patients with lower lung zone-dominant sarcoidosis had an older age and lower baseline FVC with disease progression and acute deterioration associated with higher long-term mortality.