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<\/a><\/p>\nHere’s a higher power showing the collection of lymphocytes, macrophages, plasma cells, reactive pneumocytes, and a couple of intraalveolar giant cells, as well as some alveolar wall fibrosis.<\/p>\n
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A 70-year-old man was found dead in his apartment.\u00a0 At autopsy, external exam revealed minor trauma consistent with collapse and fall.\u00a0 Internal examination demonstrated emphysema, mild interstitial pneumonia, and alveoli filled with macrophages and occasional giant cells, without granuloma formation.\u00a0 He also had severe coronary artery disease, cardiomegaly,\u00a0 and severe arteriosclerosis of the aorta.<\/p>\n
The findings in the lungs were not something that I had run into before.\u00a0 Lungs with giant cells are not that uncommon in today’s world where drug use is common, but these are primarily found in alveolar walls and often form microgranulomata or fully formed granulomata.\u00a0 I’m not used to seeing just the occasional giant cell floating around in alveoli.\u00a0 At the top of the differential is so-called “hard metal lung disease,” which is an interstitial pneumonitis chracterised by macrophages filling up alveoli along with occasional giant cells.\u00a0 Granulomata have been noted, but are rare.\u00a0 There’s often a restrictive lung disease component, with interstitial fibrosis.\u00a0 Bronchiolitis is also common.\u00a0 Hard metal lung disease is seen in people who work with tungsten steel, foundries, and other metal work.\u00a0 More recent studies have suggested that the primary culprit is cobalt, and it’s an autoimmune disease with variable prognosis.\u00a0 It usually stops progressing, and often regresses, once the offending exposures stop.<\/p>\n
I talked to the decedent’s family and asked if he had worked in a foundry or something like that.\u00a0 She told me that he had worked in a metal finishing plant making tools for a few years a couple of decades ago.<\/p>\n
The photographs are not great.\u00a0 This is an earlier case of mine, back when I had a rather poor digital camera and cobbled-together light tubes.\u00a0 Still, it shows some of the primary characteristics.<\/p>\n
First, here’s a low power.\u00a0 Yes, it’s fuzzy.\u00a0 Still, you can see the alveoli filled with mononuclear cells and occasional giant cells.\u00a0 There’s expansion and fibrosis of the interstitium in some places.\u00a0 There’s also a bronchiolitis, but it’s hard to make out with poor focus.<\/p>\n
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Here’s a higher power showing the collection of lymphocytes, macrophages, plasma cells, reactive pneumocytes, and a couple of intraalveolar giant cells, as well as some alveolar wall fibrosis.<\/p>\n <\/p>\n<\/a><\/p>\n