Aluminium dust-induced lung disease in the pyro-powder-producing industry:detection by high-resolution computed tomography

Objective: The aim of this case study was to investigate the suitability of high-resolution computed tomography (HRCT) for detecting early stages of l ung fibrosis induced by aluminium (Al) dust. Methods: A 40-year-old worker was studied who had worked as a stamper for 1 4 years in a plant producing aluminium powder and had been exposed to high levels of aluminium dust during this time. The investigation included the c ollection of general data on health and details on occupational history, im munological tests, a physical examination, lung function analysis, biologic al monitoring of Al in plasma and urine, chest X-rays and HRCT. Results: For many years the man has suffered from an exercise-induced short ness of breath. Lung function analysis revealed a reduction of the vital ca pacity to 57.5% of the predicted value. The Al concentration in plasma was 41.0 mu g/l (upper reference value 10 mu g/l) and in urine 407.4 mu g/l [up per reference value 15 mu g/l, biological tolerance (BAT) value 200 mu g/l] at the time of diagnosis. Chest X-ray showed unspecific changes. HRCT find ings were characterised by small, centrilobular, nodular opacities and slig htly thickened interlobular septae. Exposure to other fibrotic agents could be excluded. Conclusions: HRCT was more sensitive than chest X-rays for detecting this e arly stage of Al-dust-induced lung disease. The suitability of HRCT in the surveillance of workers highly exposed to aluminium powder should be evalua ted in further studies. Biological monitoring can be used to workers at hig h risk.