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Fluro-deoxygenase-positron emission tomography/computed tomography in hard metal lung disease.

Iyer K, Karkhanis V, Basu S, Joshi JM - Lung India (2015 Sep-Oct)

Bottom Line: We report a case of a diamond polisher where FDG-PET/CT was helpful in identifying active inflammation in hard metal lung disease (HMLD) caused by cobalt exposure.

View Article: PubMed Central - PubMed

Affiliation: Department of Pulmonary Medicine, Topiwala National Medical College, BYL Nair Hospital, Mumbai, Maharashtra, India.

ABSTRACT
We report a case of a diamond polisher where FDG-PET/CT was helpful in identifying active inflammation in hard metal lung disease (HMLD) caused by cobalt exposure.

No MeSH data available.


Related in: MedlinePlus

Digital chest radiograph (posterior anterior view) showing bilateral reticulonodular opacities
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Figure 1: Digital chest radiograph (posterior anterior view) showing bilateral reticulonodular opacities

Mentions: A 41-year-old man, worked as a diamond polisher for more than 15 years, presented to our department with a 3-year history of dry cough and progressive breathlessness on exertion. Examination revealed grade 3 clubbing, exercise desaturation and bilateral bibasilar fine end inspiratory crackles. Routine hematological and biochemical values were normal including ACE level as 33U/l. An arterial blood gas analysis was normal but showed an increased alveolar-arterial gradient. Chest radiograph [Figure 1] showed bilateral reticulonodular opacities. Spirometry was suggestive of severe restrictive abnormality with forced vital capacity (FVC) of 1.38 liters (31%), forced expiratory volume in first second (FEV1) of 1.24 liters (35%), FEV1/FVC ratio of 89, and diffusion of lung for carbon monoxide (DLCO) of 10.08 ml/min/mmHg (35% predicted). High-resolution computed tomography (HRCT) of thorax revealed ill-defined patchy areas of confluent centrilobular nodules with a central and peripheral distribution pattern and fissural nodules with mildly enlarged mediastinal lymph nodes [Figure 2]. Whole body positron emission tomography – computed tomography (WB PET-CT) was done to see extent of underlying inflammation. It showed diffuse low-grade fluorodeoxy glucose (FDG) uptake in bilateral lungs with sparing of peripheral right middle lobe laterally, and low to moderate FDG uptake in right paratracheal, subcarinal, right tracheobronchial, bilateral hilar, bilateral inguinal lymph nodes and aortopulmonary window [Figure 3]. An analysis of the powder used for polishing diamonds at his workplace was performed. It revealed a high quantity of Cobalt -24.65 parts per million. The patient refused lung biopsy. However, in view of significant occupational exposure to cobalt, HRCT findings and normal ACE levels, diagnosis of hard metal disease due to cobalt exposure was made. He was advised to change his job. Steroids i.e., tablet prednisolone 40 mg was given as diagnosis could not be proven with biopsy and FDG-PET scan showed increased uptake suggesting underlying inflammation. One year later his lung functions were stable with FVC-1.38, FEV1-1.29 and FEV1/FVC ratio-93. Follow-up HRCT after 1 year showed similar findings as baseline.


Fluro-deoxygenase-positron emission tomography/computed tomography in hard metal lung disease.

Iyer K, Karkhanis V, Basu S, Joshi JM - Lung India (2015 Sep-Oct)

Digital chest radiograph (posterior anterior view) showing bilateral reticulonodular opacities
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4587003&req=5

Figure 1: Digital chest radiograph (posterior anterior view) showing bilateral reticulonodular opacities
Mentions: A 41-year-old man, worked as a diamond polisher for more than 15 years, presented to our department with a 3-year history of dry cough and progressive breathlessness on exertion. Examination revealed grade 3 clubbing, exercise desaturation and bilateral bibasilar fine end inspiratory crackles. Routine hematological and biochemical values were normal including ACE level as 33U/l. An arterial blood gas analysis was normal but showed an increased alveolar-arterial gradient. Chest radiograph [Figure 1] showed bilateral reticulonodular opacities. Spirometry was suggestive of severe restrictive abnormality with forced vital capacity (FVC) of 1.38 liters (31%), forced expiratory volume in first second (FEV1) of 1.24 liters (35%), FEV1/FVC ratio of 89, and diffusion of lung for carbon monoxide (DLCO) of 10.08 ml/min/mmHg (35% predicted). High-resolution computed tomography (HRCT) of thorax revealed ill-defined patchy areas of confluent centrilobular nodules with a central and peripheral distribution pattern and fissural nodules with mildly enlarged mediastinal lymph nodes [Figure 2]. Whole body positron emission tomography – computed tomography (WB PET-CT) was done to see extent of underlying inflammation. It showed diffuse low-grade fluorodeoxy glucose (FDG) uptake in bilateral lungs with sparing of peripheral right middle lobe laterally, and low to moderate FDG uptake in right paratracheal, subcarinal, right tracheobronchial, bilateral hilar, bilateral inguinal lymph nodes and aortopulmonary window [Figure 3]. An analysis of the powder used for polishing diamonds at his workplace was performed. It revealed a high quantity of Cobalt -24.65 parts per million. The patient refused lung biopsy. However, in view of significant occupational exposure to cobalt, HRCT findings and normal ACE levels, diagnosis of hard metal disease due to cobalt exposure was made. He was advised to change his job. Steroids i.e., tablet prednisolone 40 mg was given as diagnosis could not be proven with biopsy and FDG-PET scan showed increased uptake suggesting underlying inflammation. One year later his lung functions were stable with FVC-1.38, FEV1-1.29 and FEV1/FVC ratio-93. Follow-up HRCT after 1 year showed similar findings as baseline.

Bottom Line: We report a case of a diamond polisher where FDG-PET/CT was helpful in identifying active inflammation in hard metal lung disease (HMLD) caused by cobalt exposure.

View Article: PubMed Central - PubMed

Affiliation: Department of Pulmonary Medicine, Topiwala National Medical College, BYL Nair Hospital, Mumbai, Maharashtra, India.

ABSTRACT
We report a case of a diamond polisher where FDG-PET/CT was helpful in identifying active inflammation in hard metal lung disease (HMLD) caused by cobalt exposure.

No MeSH data available.


Related in: MedlinePlus