Authors: Maoxin Wu1, Ronald E. Gordon1, Robin Herbert2, Maria Padilla3, Jacqueline Moline2, David Mendelson4, Virginia Litle5*, William D. Travis6, Joan Gil1
Environmental Health Perspectives

1 Department of Pathology, 2 Department of Community and Preventive Medicine, 3 Division of Pulmonary and Sleep Medicine, 4 Department of Radiology, and, 5 Department of Thoracic Surgery, Mount Sinai School of Medicine, New York, New York, USA, 6 Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, New York, USA

Abstract Top

Context: After the collapse of the World Trade Center (WTC) on 11 September 2001, a dense cloud of dust containing high levels of airborne pollutants covered Manhattan and parts of Brooklyn, New York. Between 60,000 and 70,000 responders were exposed. Many reported adverse health effects.

Case presentation: In this report we describe clinical, pathologic, and mineralogic findings in seven previously healthy responders who were exposed to WTC dust on either 11 September or 12 September 2001, who developed severe respiratory impairment or unexplained radiologic findings and underwent video-assisted thoracoscopic surgical lung biopsy procedures at Mount Sinai Medical Center. WTC dust samples were also examined. We found that three of the seven responders had severe or moderate restrictive disease clinically. Histopathology showed interstitial lung disease consistent with small airways disease, bronchiolocentric parenchymal disease, and nonnecrotizing granulomatous condition. Tissue mineralogic analyses showed variable amounts of sheets of aluminum and magnesium silicates, chrysotile asbestos, calcium phosphate, and calcium sulfate. Small shards of glass containing mostly silica and magnesium were also found. Carbon nanotubes (CNT) of various sizes and lengths were noted. CNT were also identified in four of seven WTC dust samples.

Discussion: These findings confirm the previously reported association between WTC dust exposure and bronchiolar and interstitial lung disease. Long-term monitoring of responders will be needed to elucidate the full extent of this problem. The finding of CNT in both WTC dust and lung tissues is unexpected and requires further study.

On 11 September 2001 (9/11), lower Manhattan and parts of Brooklyn were engulfed by a dense cloud of toxic and irritant dust and smoke generated by the collapse of the World Trade Center (WTC) towers (Landrigan et al. 2004; Levin et al. 2002; Lioy et al. 2002). This cloud comprised a complex mix of pollutants, among them the products of combustion of 91,000 L jet fuel, pulverized building materials, cement dust, asbestos, microscopic shards of glass, silica, heavy metals, and numerous organic compounds [see Supplemental Material, Table 1 (doi:10.1289/ehp.0901159)] (Edelman et al. 2003; McGee et al. 2003; Prezant et al. 2002; Reibman et al. 2005).
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Table 1.

Summary of findings in pathology and minerologic/asbestos fiber burden analyses.

Adverse health effects have developed since 9/11 in workers and volunteers involved in the rescue, relief, and cleanup at the WTC site and at the Staten Island landfill (the major wreckage depository) (Edelman et al. 2003; Herbert et al. 2006; Landrigan et al. 2004; Lioy et al. 2002; Prezant et al. 2002). The health effects most commonly observed involved the upper and lower respiratory tract. Signs, symptoms, and findings include persistent cough, breathlessness, wheezing, asthma, sinusitis, laryngitis, and irritant-induced asthma, also named reactive airways dysfunction syndrome (RADS) (Herbert et al. 2006; Levin et al. 2002; Prezant et al. 2002). Cases of interstitial lung disease have also been reported, including acute eosinophilic pneumonia, granulomatous pneumonitis, sarcoidosis, and bronchiolitis obliterans (Izbicki et al. 2007; Mann et al. 2005; Rom et al. 2002; Safirstein et al. 2003).

The Mount Sinai WTC Medical Monitoring and Treatment Program (MMTP) was established to provide standardized screening and facilitate treatment of eligible responders who worked or volunteered at the WTC site. There is no systemic or comprehensive roster of all responders similar to the existing records of responders from the New York City uniformed services, such as the Fire Department of New York (FDNY) or New York Police Department, which frequently include their previous health condition. Estimates of the number of responders given by different sources range from 50,000 to 90,000 in total; we believe that the total, including FDNY workers, is likely to have been between 60,000 and 70,000 (Moline et al. 2009). In this article, we report on a case series of seven WTC responders enrolled in the Mount Sinai WTC MMTP who underwent video-assisted thoracoscopic (VATS) procedures at the Mount Sinai Medical Center and whose WTC exposures began on either 11 September or 12 September 2001. As of 11 September 2007, a total of 12,891 responders claiming first- and/or second-day exposure to the WTC pile had monitoring examinations at the Mount Sinai MMTP on or before 11 September 2007. Of these responders, one underwent VATS with biopsy in 2005, and six underwent VATS procedures between 1 January and 31 October 2007, because of severe pulmonary symptoms, impairment, or unexplained radiologic findings. We describe here the histopathologic patterns associated with these severe forms of respiratory impairment.

As part of our overall biopsy examination, we performed mineralogic analyses of the tissue from seven individuals believed to have been previously healthy who developed signs of respiratory impairment after sustaining WTC exposures. Additionally, we obtained and analyzed dust specimens collected on the site (DS) and examined old specimens (controls for old cases; COC) unrelated to the WTC disaster that were routinely submitted to our laboratory for asbestos burden analysis (n = 40) or obtained for research purposes from autopsy or surgical specimens (n = 20) of patients without history of WTC exposure.

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