Sideroelastosis of pulmonary vessels after welder dust exposure

Sideroelastosis pulmonum was first described by Ceelen (1931) and Gellerstedt (1939), mentioning an idiopathic type, but also vascular alterations in chronic pulmonary congestion. We analysed the question wether secondary sideroelastosis can be demonstrated also in lungs after previous welder dust exposure. Lung samples of 43 patients and deceased with various exposure periods to welder dust were investigated. On each sample,light microscopical,scan electron microscopical and energy dispersive x-ray micro analyses (EDX) were performed. In six samples (14%) vascular alterations in the area of denaturated elastic fibres with siderophilic "impregnation" were seen, corresponding to the features described by von Ceelen and Gellerstedt.Giant cell or granulomatous reactions, however, were present only in exceptional cases. This phenomenon was seen mostly in cases of marked local siderin deposits and reactive fibrosis. Using EDX, a number of metals characteristic for welder dust (Al,Tl, Cr, Ni) as well as iron were found in siderophages. No other metal than iron was detected in siderophilic elastic fibres using EDX. Causal pathogenetically, a correlation between increased iron uptake connected with welding particles and sideroelastosis of the vessel walls has to be established. However, in formal pathogenesis, other factors such as local perfusion disturbances due to fibrotic processes after exposure to harmful substances must be taken into consideration.