Pulmonary Fibrosis and Encephalopathy Associated with the Inhalation of Aluminium Dust

Abstract

The clinical, radiographic, pathological, and environmental features of a case of extensive aluminium fibrosis of the lungs are reported in a man of 49 years of age who had worked for 131 years in the ball-mill room of an aluminium powder factory.It is noteworthy that his symptoms were referable to the central nervous system, and that he died from terminal broncho-pneumonia following a rapidly progressive encephalopathy, associated with epileptiform attacks. He had no presenting pulmonary symptoms, and x-ray examination of the chest showed only slight abnormalities. Radiographic examination of the chests of 53 other workers in the same factory, and clinical examination with lung function tests of 23 of them revealed no other definite cases of aluminium fibrosis of the lung, nor any other cases with neurological signs and symptoms.Estimations of the aluminium contents of the body tissues such as the lungs, brain, liver, and bone are also recorded. When compared with normal values, it was found that the lungs and brain contained about 20 times and the liver 122 times more than normal. As a contribution to the study of the aluminium content of normal tissues, and as a control series for the results given by Tipton, Cook, Steiner, Foland, McDaniel, and Fentress (1957), and Tipton, Cook, Foland, Rittner, Hardwick, and McDaniel (1958, 1959, the aluminium content of eight "normal" brains was estimated and in all cases it was found to be less than 0-6 p.g. Al/g. wet weight.

Exposure and urinary excretion of aluminum during welding.

“…There is only one case of encephalopathy which has been associated with occupational exposure to aluminum. This man was exposed to aluminum powder for 13 years, and his lungs had 18 times the normal amount of aluminum and his liver had 120 times the normal level (9). These results indicate that several organs, eg, the lungs, liver, spleen, and bones , can store aluminum after long-term exposure.…”

Inorganic dust pneumonias: the metal-related parenchymal disorders.

“…Stamped aluminum powder is used in the manufacture of pyrotechnics and aluminum dyes. Reports of severe fibrosis of the lungs due to exposure have been primarily from European sources (12)(13)(14)(15), and a dose-response relationship has been suggested. Cases (19).…”

The etiology of occupational pulmonary aluminosis - the past and the present

“…For example, he found signs of pulmonary aluminosis in 26% of 628 workers from 6 plants producing aluminium powder for ammunition; his patients presented with cough, dyspnea, rather reticular opacities in the apex or middle lung fields and pulmonary fibrosis 5,7 . He considered the use of stearic acid as an additive in aluminium powder production as safer than e. g. the use of mineral oil, with this opinion being supported by other experts in the following decades 7,8 . Also in the 1940s, thirty-five cases of pulmonary fibrosis were reported among 344 Canadian aluminium potroom workers with exposure in the manufacture of alumina abrasives by Shaver and Riddel.…”

“…Later, subpleural bullous emphysema is frequent, potentially complicated by spontaneous pneumothorax, with recent studies suggesting possible association with higher serum aluminium levels 6,12,28,29 . In advanced stages, severe pulmonary fibrosis with honeycombing was described 8,12,14,16,[30][31][32] . Traditionally, the highest risk with respect to potential lung damage is reported to be associated with processes in bauxite smelting, the use of fine aluminium powder in the manufacture of explosives and, last but not least, exposure to aluminium welding fumes, as shown in more recent case reports [33][34][35][36][37] .…”