CTICasesHard Metal Interstitial Lung Disease (Cobalt and Tungsten Exposure)
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Imaging findings
Chest radiographs and CT show severe, upper-lung predominant fibrosing interstitial lung disease with extensive reticulation, traction bronchiectasis, volume loss, and associated pneumomediastinum (evidenced by a "double wall sign" along the trachea). Pathological examination from a surgical biopsy confirmed hard metal pneumoconiosis due to cobalt and tungsten exposure.
Key takeaways
Hard metal lung disease is a rare pneumoconiosis caused by occupational exposure to inhaled cobalt, tungsten, or other heavy metals. Unlike idiopathic pulmonary fibrosis, it often presents with an upper-lung predominant fibrotic pattern and can be complicated by spontaneous air leaks such as pneumomediastinum.
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