PMC6463652_01
The patient was engaged in shaving ring-shaped aluminum material, such as the upper 2 images, and making camera parts, like the one below (a), with a curving machine (b). Workers are required to pour cutting oil on the material while cutting, as in (b), but our patient failed to do so, suggesting he might have inhaled a larger amount of aluminum-containing fumes than other worker in this occupation
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Fig1
He did not wear a dust respirator and worked closely to the cutting machine (Fig. 1) because of his poor eyesight.
Chest X-ray showing bilateral pleural thickening in the upper and middle lung fields. The lung volume was reduced and reticulonodular shadows extended from the sub-pleura to deep inside the lungs, suggesting pulmonary fibrosis. The tracheal bifurcation was widened by traction of the upper lobes
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Fig2
Chest X-ray showed linear and reticulonodular shadows with marked bilateral pleural thickening in the upper lung fields (Fig. 2).
High-resolution computed tomography showing severe bilateral pleural thickening with shrunken and distorted upper lobes (a, c). There was mediastinal emphysema (a). On the other hand, reticulonodular shadows and bronchiectasis were distributed deep inside the lower lung (b, c)
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Fig3
Chest CT indicated bilateral dense sub-pleural consolidation, bronchiectasis and ground glass opacities in the bilateral upper lobes (Fig. 3).
Elemental analysis of the biopsy specimen by electron probe X-ray microanalysis (EPMA). Aluminum was identified in a fragment of bronchial wall obtained by trans-bronchial lung biopsy (TBLB), after staining with hematoxylin and eosin (a). Deposition of elements in the specimen was shown by red to yellow colours. The green colour indicated deposition of nitrogen as a control. Significant amounts of aluminum were identified by EPMA as shown by red to yellow colours (b), whereas iron and silica were detected in much lower amounts compared with aluminum (c, d)
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Fig4
On elemental analysis of the biopsy specimen, a relatively high amount of aluminum was detected in comparison to trace amounts of other elements, including iron and silica (Fig.4).